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Pre-registration form for SaferNanomaterials 2021

Please complete the pre-registration form to obtain your unique user credentials. You will need these to continue the application process.

Personal Information (pre-registration)

(*) Merci de remplir les champs obligatoires

(*) School

bioHC-SaferNanomaterials

(*) School year

2021

(*) Family name

(*) Given name

(*) Gender

Male Female

(*) Date of birth

(*) Town of birth

(*) Country of birth

(*) Current nationality

(*) Email address

(*) Current status

Student of medicine / Pharmacy Master student PHD Student Medical / Healthcare professional Other Professional / post-doc

Educational Establishment

(*) Name

(*) City

(*) Country

Employer

(*) Name

(*) City

(*) Country

(*) Are you employed or in an internship at CERN ?

Yes No

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