Application for the

GENETIC LINKAGE COURSE

MDC, Berlin, July 7-10, 2009

Please fill out this page and submit it by E-mail to Dr. Suzanne M. Leal. Please simply paste the form into a body of an e-mail and fill out the form.

Your name & title: __________________________________________________

Company / University __________________________________________________

Department: __________________________________________________

Address: _________________________________________________

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Tel. number: _________________________________________________

Fax number: __________________________________________________

E-mail: __________________________________________________

Special Interests (e.g. Hearing impairment, coronary disease, method development, etc) _______________________________________

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MDC housing:

(___) I wish to use housing at the MDC campus.

(___) I will make my own hotel arrangements.

Note: Due to a limited number of rooms, we cannot guarantee housing at the MDC. We will forward information on how to make reservations at MDC at a later date – please note that we do not make the reservations for you, this question is asked so we may inform MDC of approximately how many people will be requesting housing.

Applications are accepted on a "first come, first served" basis. Applications will be accepted after the due date; if the course is filled, the applicant will be placed on the waiting list.

Payments directions: Please send no money now. Applicants accepted for the course will receive payment instructions.