REGISTRATION FORM
JNVE congress
14 and 15 November 2014
Science Park Amsterdam
PLEASE COMPLETE IN CAPITAL LETTERS!!
Name:
……………………………………………… First name: ……………..…………………................
Address:
………………………………………………………..................……....……………………..............
Zip code:
.……...………….…... Residence: ….……………………………….....…….................................
E-mail:
………………………….............................................. Dietary requirements: ..........................
Are you a medical doctor yes/ no
If yes, BIG-registration number: …….............................................................................................................
hereby applies for participation of the JNVE congress
The costs of this meeting are as follows (circle choice):
Day programme (including booklet, lunch, drinks,
diner and social program)
€ 80,00
Day programme including hotel accommodation
based on a double room with breakfast.
€ 110,00
If known, please indicate the name of a preferred
roommate here:
The registration fee should be transferred before October 17, 2014 to the ING account number:
511341 att: Nederlandse Vereninging voor Endocrinologie, Castricum, stating the same name as on
this application form, followed by JNVE congress.
Registration and booking of the room follows only after receipt of the registration fee! If the payment
has not been credited to the account of the NVE, no room is reserved.
Before November 1, 2014 refund of payments is granted after deduction of € 15,- administration charges.
After November 1, 2014, no refund of payments is granted anymore.
Abstracts:
We welcome a broad range in endocrine-related topics including clinical and fundamental (animal) research.
Please register before submitting your abstract. The official language of the meeting, including oral
presentations, is English. Abstracts are limited to a maximum of 250 words excluding authors and affiliations.
Please submit the abstract in Times New Roman, 12 point size, line spacing single.
I would like to present my research:
Title:
………………………….………………………………………………………………………………..
Authors:
…………………….……………………………………………………………………………………..
Institute:
..………………………………………………………………………………………….………………
How many years have you been working on your PhD: 1 / 2 / 3 / 4 / 5 / postdoc / other…………………...……
Optional: if you would like a self portrait being placed in the program, please submit a photograph.
Abstract deadline is September 14, 2014.
Please send this form and your abstract to JNVE@NVE.NL