APPLICATION FORM
South America Regional Biosafety Course: “Holistic Foundations for Assessment and
Regulation of Genetic Engineering and Genetically Modified
Organisms” (SARBioC)
Lima – Peru; 19 th - 24th March 2007
Surname(s):
Date of birth (day/month/year):
First names(s):
Country of birth:
Sex :Female
Nationality:
Name of organisation:
Present position(s) (type and level):
Telephone:
Fax:
E-mail:
Postal address of your organisation:
Street address (if different):
Working language(s) (in order of fluency):
State the reasons for your interest in the course:
How will your work benefit from your participation in the course?
Academic qualifications:
Work experience:
Special requirements (dietary, wheelchair access, other):
Sponsorship required:
Yes
Date:
No
Signature: (not necessary if you send by e-mail)
Send by Outlook
In addition to this form, the application should also include a brief CV; listing your education (degrees etc.), your
work experience, and, if applicable, a list of publications.
The working language of the course will be English only, and as such, applicants should be able to work
sufficiently well in English.
Preference will be given to applicants from developing countries (Official Development Assistance-countries).
Gender and regional criteria are also used in the selection of participants.
Your application should be received by the Norwegian Institute of Gene Ecology no later than 1 February 2007.
Submit your application:
Online on our website at: www.asdmas.com/bioseguidad/registration
(Remember to e-mail your CV to asdmas@asdmas.com)
By e-mail to: asdmas@asdmas.com or by fax to: + 51 1 479 2866 or
By mail to:
GenØk - Norsk institutt for genøkologi
Att. Katrine Jaklin
Forskningsparken i Breivika
P.O. Box 6418 - 9294 Tromsø –Norway
Telephone: (+47) 77 64 66 20
Telefax: (+47) 77 64 61 00 (adm.)/ (+47) 77 64 61 51 (lab.)
Web: www.genok.org
Asociación Desarrollo Medio Ambiental Sustentable (ASDMAS)
Att: Antonietta Gutièrrez Rosati
Avenida La Molina 2135 Sol de la Molina
Lima 12- Peru
Phone: +51 1 479 2866
Web: www.asdmas.com