Registration form for INTERNATIONAL CONFERENCE
“Signaling Processes and Structures
in Nervous System in Health and Disease ”

SEPTEMBER 19 - 20, 2003
Dresden, Germany

Prelimnary deadline for registration : July 18, 2003



Name, First Name, Title  :

Institute / Company :

Address                   :
 

City :                                         Zip Code :                                Country:
 

E-mail :

Tel. :                                                                  Fax. :
 
 

 The registration fee of Euro...............

was transferred to the account below

Reference: GBM SG 2003DR (Please indicate name of participant)
 
      Vereins- und Westbank Magdeburg , account no. 29844092, BLZ / Bank Code no.:200 300 00, 

                                                                    account holder: Prof. G. Reiser
IBAN: DE55 2003 0000 0029 8440 92; SWIFT (BIC): VUWBDEHHXXX

   

I am a
   GBM- Member
   GBM -Junior Member (under the age of 32)
   Non Member
   Student Non Member (under the age of 32)
   I would like to present a poster
   The poster abstract is enclosed
   The poster abstract has be submitted by e-mail (WinWord97-Format)
   I am not presenting a poster
   I would like to present a short talk about my poster
   I am not presenting a short talk

Date:                                               Signature:
 

Registration Fees:

 GBM Member                                                             € 55.00

 GBM Non Member                                                     € 65.00

 GBM Junior member (under the age of 32)                   € 25.00

 Student  non member (under the age of 32)                   € 35.00

 

 

Mail / Fax the above form to:
Prof. Dr. Georg Reiser,
Professor and Head
Institut für Neurobiochemie,
Otto-von-Guericke-Universität Magdeburg
Medizinische Fakultät, Leipziger Str.44, 39120 Magdeburg, Germany
E-mail: georg.reiser@medizin.uni-magdeburg.de
Fax. : +49-391-67 13097

Download as Word Document