Application Form for Workshop

December 10th to14th 2012:

Application/Registration Form:

(Please submit your form before October 30, 2012 )

Last name:

First Name

Middle Name :

Current Institutional Affiliation
 

Address :

City:

State/Country

Zip code:

Tel. (with STD code)

Fax :

e-mail :

Home Address :

City:

State/Country:

Zip code:

 
Tel. (with STD code)

Fax :

e-mail :

Education: (Indicate institution and year)
 

Undergraduate:

Graduate:

Post-Graduate:

Current status: Student/ Postdoctoral/ Staff/ Faculty/ Other
 
   
Separately, please provide your reasons for wanting to take this course.
Include your research interest and experience (if any) you have had in molecular biology.
 



Registration Fees:
Selected Participants will have to pay Rs. 15,000/-. Cheques/ DD should be
in favour of “ FRIGE, Ahmedabad”. Only 10 participants will be selected for the course and will be notified in due time.

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