Design, preparation and preclinical validation of MRI probes
for Molecular Imaging applications
Torino - ITALY – September 12 (2.00 pm)to 15 (1.00 pm), 2016
(959 – TS 5)
Please complete the registration form and send it by email or fax to :
INMiND Training Office
Fax: +33 1 69 08 97 77 – e-mail: mailto:
Family name : ...... First name : ......
Date of birth (Day/Month/Year) : ...... Gender : F M
Place of birth : ...... Nationality: ......
Institution/Company name : ......
Laboratory / Group research name :......
Phone : ...... Fax : ......
E-mail : ...... Web site : ......
Position : PhD student post-doc researcher physician
professor technician other Please specify :......
Address of invoice(*):......
......
......
City Code :...... City : ......
Country : ......
Is your laboratory member of the INMiND Network :yes no
Registration fees :
INMiND members: 150 €
Academic : 300 € Industrial : 600 €
(*) If your Account Department requests a special mention on the invoice,
please be so kind to indicate it here :......
Registration feescanbe paid:
by cashier’s check to the order of CEA Saclay
by bank transferfor the full amount(any bank charges are payable by the participant):
Account holderCommissariat Energie Atomique CEA
Bank nameBNP
Bank branch addressParis Place Vendome (00818)
Bank account number30004 00818 00021216221 27
IBANFR76 3000 4008 1800 0212 1622 127
BICBNPAFRPPPVD
The bank transfer must clearly state the name of the participant, the training course reference as well as the following mention : "INMiND training 959/INSTN". In case of payment made for more than one participant, please make sure that each name is properly indicated.
Deadline of payment :Two weeks before the beginning of the course(please make sure that you have received a confirmation of pre-registration from us before you pay).
You will be registered only on receipt of payment. The bank transfer or at least proof of payment (i.e. a copy of the bank transfer order) should be sent by this deadline.
Terms of sale :
Any course that is begun will be invoiced in full.In case of non-presence during the training course, please note that there will have no refund of the registration fees, except for an absence due to a medical problem that can be duly supported by certificate – a copy of the medical leave form will be requested.Please also notice that in case of withdrawal, the cancellation must be confirmed in writing at least 14calendar daysbefore the start of the training course; otherwise the registration fees will be due in full.
Invoices are issued at the end of the training courseand will be sent by mail to the invoice address written on this registration form. No invoice will be reissued.
We would like to know more about your interest in molecular imaging technology. Therefore we invite you to answer the following questions :
Research interest : ......
......
What do you expect from this training course ? ......
......
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INMiND Training Office
INSTN / SOLSS – Centre CEA de Saclay
Point Courrier 35 – 91191 Gif-sur-Yvette Cedex, France
e-mail: