PRE-REGISTRATION FORM

Thirteenth course “Clinical Cytogenetics”, Goldrain Castle (BZ), Italy

Goldrain Castle (BZ), Italy, Aug. 31 to Sept. 7, 2019

Family Name First Name Birthdates…………..Sex……..

Address for correspondence (professional or private)_
Zipcode____Country______ __________________
Telephone (Country code) (Area code) (Number)
Fax (Country code) (Area code) (Number)
E-mail
Affiliation (Institute, Laboratory or Hospital)

Professional background of the applicant

I have completed

Medical School in (year)

University studies in (year)

Biology
Others, please specify:
Degree obtained:

I have worked in a cytogenetic and/or molecular cytogenetic laboratory

Institution, location:
Head, supervisor:
From ……………..to

I have worked in clinical genetics and genetic counselling

Institution, location
Head, supervisor
From to

I am a member of ECA of ESHG

Yes no Yes no

I am a member of another association of cytogeneticists

Yes, specify
No

I have already used the ECARUCA database and have an account

Yes no
Pre-registration & Accommodation
I wish to register for the course and to reserve a room in the dormitory of the Goldrain Conference
Center or in a nearby hotel. Please put a x in front of your choice.
single room
– double room to be shared with another student
– double room to be shared with a partner not attending the course
Registration fee € 1400.- for a single bed room. € 1200.- for a double bed room. If you want to share
a room with an unknown other participant, you can profit from the lower fee only if there is another
such registered. If you want to bring your partner who does not attend the course, your fee is still €
1300.-, and the partner should pay the additional fee directly at arrival to the staff of the castle; it
would be € 70.- per day for full pension, and less depending on the meals not consumed (for details
see announcement).

The registration fee includes accommodation for seven nights, meals for August 31 th to September
7th, dinner on the 31th of August and breakfast on the 7 th of September. It excludes transportation to
and from Goldrain and a second bed in a double room for non-participants.
Since there is a limited number of participants (50 at maximum, including the lecturers and stuff) and
rooms, we recommend that you register at your earliest convenience.
Note: After we have received your pre-registration form, we will inform you about acceptance of your
application and send you information about payment of the registration fee. Registration will be accepted
only after confirmation by the bank that the registration fee has arrived. Confirmation of registration will be
communicated by email to the address above together with further information about travel and other
details about the course.

Please, send the pre-registration form via e-mail to schinzel@medgen.uzh.ch and

Miller.Konstantin@mh-hannover.de