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Registration Form
HANDS-ON WORKSHOP ON ADVANCING ZEBRAFISH HEALTH PROGRAMS
June 26-27, 2017, Champalimaud Foundation, Lisbon, Portugal

Payments should be done by bank transfer to:
FUND A S C C M CHAMPALIMAUD
IBAN PT50 0035 0396 00219545830 82

Registrations are only validated upon receiving proof of payment or Purchase Order (to be sent to ana.certal@research.fchampalimaud.org).

Name (first and last)
E-mail
Affiliation
Please use the format: Institute/University, City, Country
Position
Please indicate your position within your Institution
Are you a member of the Zebrafish Husbandry Association (ZHA)?
Required
Would you like to attend the Workshop Dinner?
Required
Name for Invoice
Address for Invoice
VAT number
Submit
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