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GPEN 2014
Registration Form
GPEN 2014 registration
* required items
Personal
Title
*
– select title –
Dr.
Professor
Mr.
Mrs.
Ms.
Miss.
First name
*
Middle name
Last name
*
Profession
Current position or job title
GPEN member organisation
*
– select organization –
Abo Academy University
Aston University
Chulalongkorn University
Chungnam National University
ETH-Zurich
Hacettepe University
Hebrew University of Jerusalem
Kanazawa University
Katholieke Universiteit Leuven
Kumamoto University
Kyoto University
Leiden University
Marburg University
Monash University
National University of Singapore
NIPER
Paris-Sud
Purdue University
Saarland University
Seoul National University
Setsunan University
Shandong University
Southern Denmark University
UCL College of Pharmacy
University of Basel
University of California at San Francisco
University of Colorado
University of Connecticut
University of Copenhagen
University of Eastern Finland
University of Florida
University of Frankfurt
University of Geneva
University of Helsinki
University of Kansas
University of Kentucky
University of Manitoba
University of Maryland
University of Michigan
University of Minnesota
University of Nebraska
University of North Carolina
University of Otago
University of Queensland
University of Sao Paulo
University of Southern California
University of Tartu
University of Tokyo
University of Utah
University of Washington
University of Wisconsin
Uppsala University
Utrecht University
Highest academic degree(s)
Address
Address
*
Address 2
Zip/postal code
*
City
*
Country
*
– select country –
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegowina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Canary Islands
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote D’Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-bissau
Guyana
Haiti
Heard and Mc Donald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People’s Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People’s Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia, The Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (French Antilles)
Sint Maarten (Netherlands Antilles)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
St. Barthelemy
St. Eustatius
St. Helena
St. Pierre and Miquelon
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
The Democratic Republic of Congo
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City State (Holy See)
Venezuela
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna Islands
Western Sahara
Yemen
Zambia
Zimbabwe
State
– select state –
Contact
E-mail
*
Check e-mail
Telephone
*
Fax
Special Diets, Food allergies
Registration fee
Standard fee is €370
Card payments can be performed online safely with the Nets SSL-secured payment form. Our company does not have access to cardholder data, and card information is not stored on our systems. Our online store uses the international Verified by Visa and MasterCard SecureCode authentication services, which verify the identity of the cardholder. Online payments can be made with Visa, Visa Debit, Visa Electron, MasterCard, and Debit MasterCard payment cards.
Voucher code
Check voucher
Member type
Student
Faculty
Note: GPEN Sponsored participants as well as Industrial observers should register by using the voucher code that you received from your local coordinator. The registration fee includes attendance to four days of GPEN 2014 conference (August 27-30), welcome reception, social evening, conference banquet, get-together, and career centre. Not included in the registration fee are the optional trip on Sunday, August 31 and hotel accommodation.”>
Note:
GPEN Sponsored participants as well as Industrial observers should register by using the voucher code that you received from your local coordinator. The registration fee includes attendance to four days of GPEN 2014 conference (August 27-30), welcome reception, social evening, conference banquet, get-together, and career centre. Not included in the registration fee are the optional trip on Sunday, August 31 and hotel accommodation.
Accommodation — Participants should make their own hotel reservation. Hotels offering special discounts for GPEN 2014 participants are listed on the
GPEN 2014 website
. Sponsored participants are eligible to receive reimbursement for four nights of hotel accommodations (sponsored student, double occupancy)”>
Accommodation — Participants should make their own hotel reservation.
Hotels offering special discounts for GPEN 2014 participants are listed on the
GPEN 2014 website
. Sponsored participants are eligible to receive reimbursement for four nights of hotel accommodations (sponsored student, double occupancy)
Will you be participating in any of the following events?
Welcome reception, Wednesday August 27th.
Yes
No
Social evening, Thursday August 28th.
Yes
No
Conference banquet, Friday August 29th.
Yes
No
Optional trip, Sunday August 31st.
Yes
No
GPEN 2014 Career Centre
Yes
No
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*
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