		6th IMPRS NeuroCom Summer School of the UCL and MPI CBS 4 - 6 July 2016 Leipzig, Germany Registration

Information marked with a " * " is required!

1.	Personal Details

*	First Name
*	Family Name
*	Email Address
*	Confirmation of Email Address
*	Date of Birth	Year Month Day
*	Nationality

1.1	Affiliation

*	Name of University and / or Institute
*	City
*	Country
	Research Field
*	Current Degree Programme, or Job Title

1.2	Supervisor(s)

If applicable, name of academic supervisor(s)

2.	German Visa Requirements

If I am accepted, I will need to apply for a German Visa for the purpose of attending the Summer School.
(Please check here:
http://www.auswaertiges-amt.de/EN/EinreiseUndAufenthalt/Visabestimmungen_node.html
whether you will need a German visa.)

Please choose

yes no

2.1	Postal Address

If you answered the previous question with YES, we will send you an official invitation letter for the visa application procedure, following acceptance and payment of the registration fee.
Please provide your postal address:

	Addressee
	Street
	Postal Code
	City
	State
	Country

You will receive a visa letter signed by the coordinator of IMPRS NeuroCom. In case this electronically issued letter will not be accepted by the embassy/ consular authorities, please get in touch with Dr. Veronika Krieghoff of the coordination office: vkrieghoff@cbs.mpg.de

3.	Poster Presentation

Poster Session
The summer school committee will select as many posters for presentation as space allows. We will award a poster prize (refund of the summer school registration fee) for the best poster.
I would like to present a poster. (Work in progress is also accepted)

Please choose

yes no

3.1	Poster Title

The title of my poster is

3.2	Authors

Please list all authors (name and affilliation) in correct order.Example: Smith, R.J., Institute of Cognitive Neuroscience, University College London, UK

	1st Author
	2nd Author
	3rd Author
	4th Author
	5th Author
	6th Author
	7th Author
	8th Author
	9th Author
	Further Authors

3.3	Abstract

Abstract (max 250 words)

4.	Workshops

During the afternoon of July 5, 2016 each participant has the opportunity to attend a workshop. Please choose from the above listed workshops your first and second preference. Each workshop has a limited number of attendees. If the maximum number of participants is achieved we will assign places according to the “first come-first serve” principle. However, it will be guaranteed that each participant can attend a workshop.

*	First preference

*	Second preference

5.	Registration Fee

Candidates will be notified whether their application has been successful via email by May 2016. Successful candidates will then be asked to pay the registration fee of € 140. The fee covers attendance to all sessions, meals, and a conference buffet on Monday 4 July. Your travel costs and accommodation are not included. Once we have received your payment your place in the programme will be confirmed.

I am aware that participants will be charged € 140 to attend the summer school.

Date: 07/01/2025

(c) This registration system has been created by GWDG, Göttingen.