REGISTRATION FORM International Neuroscience Workshop on the theme “From Bench to Bedside: Translational Neuroscience Research in Healthy Brain Aging and Neurological Disorders” and two day symposiums from 14thto 20thDecember 2015, at the University of Sri Jayewardenepura (USJP) Please mark the relevant section that you participate; Session/ Symposium date Session/ Symposium Name Registration (LKR) fees 14th -20th December 2015 Workshop included symposiums 100 USD/ Students from SAARC & Developing countries 300USD/Graduates from Developed countries Benefits to participants 20,000/local Academics & government institutions (Inclusive of Conference Dinner) 15,000/ local Academics & government institutions ( Exclusive of Conference Dinner) 14th December 2015 Practical session on Cell culture techniques 17th December 2015 Session Natural products 17th December 2015 on (Exclusive of Conference Dinner and Plenary Discussion) EURON Session on Alzheimer Disease 6,000/local Students ( Exclusive of Conference Dinner) 20,000- Privet sector/ industries (Exclusive of Conference Dinner) 5,000 / Participants **10 participants – Hands on Training 5,000 – participants Free All A practical session on cell culture techniques will explore the development of cost effective neuro-protective therapies through emerging brain cell culture methods to delay the progress of brain disorders The use of natural products unique to Sri Lanka to foster healthy brain-aging, will delve into the potentials of bridging industry and academia in private-public partnerships with international collaborations for research and development targeting global market European Graduate School of Neuroscience opportunities for double-doctorates by EURON, under the auspicious of Director, EURON Invoice Number Please Tick for relevant section 20th December 2015 Session on Mind Relaxation in Healthy Brain Aging” Free 19th - 20th December 2015 Movement Disorder Symposium Free 17th December 2015 Conference Dinner and Plenary Discussion 5,000 – participants The objective of this symposium is to join unique resources like 2500 years old Buddhist meditation techniques with advanced technology & scientific knowledge to promote them as nonpharmacological interventions to provide health-related benefits. I foresee that this event will develop international academic collaborations in the fields of Effects of Buddhist Practices on Brain Functions leading to postgraduate degrees in MA, MSc, PhD. Dissemination of updated knowledge on recent advances in investigations, management and therapeutics of movement disorders which will lead to improvement of quality of life in movement disorder patients and facilitation of communication between clinicians and researchers to promote multidisciplinary innovative research culture in collaboration of International Movement Disorder Society. All Personnel Details: Title: [ ]Ven. []Prof. []Dr. [ ]Mr. [ ]Mrs. [ ]Miss Name with Initials: ................................................................................................................................. Given name:........................................................................................................................................... Country:.............................................. Province:........................................ City:.................................. Postal Address: ...................................................................................................................................... ………………………………………………………………………………………………................ Postal code: ............................................................................................................................................ Telephone: Mobile....................................Resident...................................Fax:………………......... E-mail:................................................................... Educational Details: Basic Degree:......................................................................................................................................... University:.............................................................................................................................................. MSc./MPhill./ PhD:............................................................................................................................... University/ Institution:............................................................................................................................ School attended: ................................................................................................................................... Occupation: ....................................................................................................................…................... Address:................................................................................................................................................. Research Interest: ..........................................................................................................….................. National/International National/International Publication Abstract National/International Poster Presentation Foreign Training **Please attacha separate detailed reference list. Explain why you are interested in this workshop and what benefit you expect to get out of attending the meeting. ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… …………………………………………………………………………………….. Date: ......................…… Signature: ........................................................ THIS FORM CAN BE COPIED Please send your Application to World Class University Project email address Email - wcup@sjp.ac.lk