Registration Form

First name*
Name*
Organization*
Address*
Postal Code / ZIP*
City*
Province / Department*
Country*
Contact Phone*
Contact Email*
Situation*	PhD student Master student Post-doctoral Public researcher Private researcher or engineer Agency, Local Authority Journalist Other
ID or Passport Number*
Accomodation preference (see below for the details)*	None: No accommodation Shared rooms (NH Constaza at 54 € / person per night, including taxes and breakfast.) Accomodation during the SSM3 School days in Barcelona: 12 nights of 10,11, 13,14,15,16,17,18, 19,20,21,22 July 2011 Non-shared rooms (NH Constaza at 108 € / person per night, including taxes and breakfast.) Accomodation during the SSM3 School days in Barcelona: 12 nights of 10,11, 13,14,15,16,17,18, 19,20,21,22 July 2011 Accomodation during the SSM3 Schhol days in Toulouse: 1 night of 12 July 2011 Other accommodation
Fellowship	A limited number of fellowships partially covering the Registration / Accomodation fees is offered by the SSM3 Organization. If you are a young student or researcher (under 35 years) and wish to apply for these fellowships, please check the box and we will contact you for details on how to apply for the fellowship. I wish to apply to the fellowships.
Poster session	A poster session will be run throughout the SSM3 Summer School on Medicines. A poster award will be offered at the end of the SSM3 Summer School to one of the posters. If you wish to present a poster about your research, please click here (box in the website) and send us a Poster Title. I wish to present at the poster session. Title

Accomodation

Shared rooms (2 persons / room)

• The organizers have negociated double rooms at the NH Constaza near the PCB. Shared room are at the price of 54 € / person per night, including taxes and breakfast.

Non-shared rooms

• OPTION A : Non-shared rooms are available at the NH Constaza at the price of 108 € / person per night, including taxes and breakfast.

For more information about the accomodation :

• NH Constanza

Payment

Registration fee: 600 €. Accomodation payment is separate.

Payment of the total amount € by bank transfer to:
IBAN: ES79 2013 0219 71 0200877896
Swift Code: CESCESBBXXX 

Bank transfers should include “Parc Científic Barcelona” as the Institution for payment, as well as your name, and the reference: “SSM3-School on Medicines”

If possible, please scan your bank transfer receipt and send it by email to: ssm3@pcb.ub.cat

Cancellation policy
If you cancel your registration in writing before May 31st , 2011, we will return 500 euros to you. If you cancel your registration before June 30th, 2011, we will return 300 euros.