Personal Data

Welcome to the online registration for the
Glia Networking Dinner at FENS Forum

The information you provide in this form is necessary to creat an invoice and for you to generate payment of your choice of meal.Your personal information will be treated confidentially.

Please fill in the registration form with all required data and confirm by clicking on the button "Next" at the bottom of the page. Boxes marked with * are mandatory and must be filled in.

Participant Type

Participant Type*

Scientist

Student/ PhD Student

Personal Information

Gender

male

female

divers

Degree

First Name*

Last Name*

Communication

E-mail address*

Additional e-mail address (CC)

Phone

Address Details

Institution

Laboratory/ Department

Street*

Postal Code*

City*

Country*

VAT number on invoice required

Yes

Please select your meal for dinner here. You can choose between a light menu (€10 incl. VAT) or a large menu (€15 incl. VAT). These are the menu options:

Light meal:
Potato pancakes with garlic + two drinks (non-alcoholic/ beer/ wine)
or Viennese sausages, 2 pieces + bread + two drinks (non-alcoholic/ beer/ wine)
or salad bowl + two drinks (non-alcoholic/ beer/ wine)
or spinach dumplings homemade, in cheese sauce with leaf salad + two drinks (non-alcoholic/ beer/ wine)

Large meal:
½ grilled pork knuckle with fresh coleslaw, homemade bread, mustard and horseradish + two drinks (non-alcoholic/ beer/ wine)

Only one menu and one option can be selected. Please make a note of your choice so that you know what you will receive during dinner.

Please select the type of meal*

Light meal

Large meal