EVENT REGISTRATION

Which event are you registering for? * Which event are you registering for? * DIAMANT Symposium Spring 2022, April 21

Would you like to attend physically or online? * Would you like to attend physically or online? * Physical attendance Online attendance

Would you like to stay at Hotel Van der Valk Utrecht on April 20? * Would you like to stay at Hotel Van der Valk Utrecht on April 20? * Yes No

Would you like to have dinner at the Hotel Van der Valk on April 20? * Would you like to have dinner at the Hotel Van der Valk on April 20? * Yes No

Menu Preference * Menu Preference * Vegan Vegetarian Fish Meat

Your name *

Other gender

Your homepage

Gender * Gender * Female Male Other

Institute/department *

Email address *

Phone number

Position * Position * Professor Associate professor (UHD) Assistant professor (UD) Postdoc PhD student Master's student Other:

Other position

Street address

Are you a DIAMANT member? * Are you a DIAMANT member? * Yes No

Would you like to propose a talk? (Only for PhD students and postdocs) Would you like to propose a talk? (Only for PhD students and postdocs) Yes No

Consent * Consent * I agree that the information I provide can be collected and stored electronically. My data will only be used for the purpose of processing and answering my request. By submitting the form I agree to the processing of my details.

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