Registration form course in Laboratory Animal Science
Department Animals in Science and Society, Course in Laboratory Animal Science, Main Office, P.O. box 80.166 3508 TD UTRECHT, The Netherlands E-mail: las@uu.nl Fax nr.: +31 (0) 30 2537997 www.uu.nl/lascourse
Please fill in (using the Tab-key) and send it as attachment together with the required documents (check out our website for more information:www.uu.nl/lascourse)to: las@uu.nl
Family name and initials
Mr / Mrs / Ms
First name:
PhD Student
Postgraduate Masterstudent (Faculty of Veterinary Medicine, Utrecht University only) Student (other)
Researcher Other
Company name:
Private address:
Zipcode, town, country
E-mail:
Tel. nr.:
Country and place of birth:
Date of birth:
Academic degree discipline year
MSc
BSc
Other
Entrance test Check out our website for more information: www.uu.nl/lascourse
Date entrance test
Preferred course:
Basic course Laboratory Animal Science with species-specific module Rodents and Rabbit Basic course Laboratory Animal Science
Species specific module Rodents and Rabbit
Preferred course date
Hotel reservation required yes / no (only applicable to the international course in July) Applied for funding from Laboratory Animals Ltd, UK yes / no
Special dietary requests (for instance vegetarian or pork free)
PPrivacy statement:
I give permission for my personal information to be used for purposes pertaining to the course in accordance with the UU Privacy Policy.
versie 8-2015
Registration form course in Laboratory Animal Science
Department Animals in Science and Society, Course in Laboratory Animal Science, Main Office, P.O. box 80.166 3508 TD UTRECHT, The Netherlands E-mail: las@uu.nl Fax nr.: +31 (0) 30 2537997 www.uu.nl/lascourse
versie 8-2015
