Registration Form

BSL-3 Workshop 2016

Biosafety for Emerging Viruses: Policy and Practice
7-9 March 2016
Eijkman Institute for Molecular Biology
Last/Family Name
First/Given Name
Title (Mr./Mrs./Ms)
Name you prefer to be called and/or
appear on nametag
Full name you prefer to appear on
certificate
Position/Job Title
Organization where you work
Postal Address
City, Country, Postal Code
Email Address
Phone No.
Fax No.
Research Interests

Current / past research projects

related to the workshop

Eijkman Institute for Molecular Biology

The Organizing Committee of BSL-3 Workshop 2016
Contact person: Adit and Sisi (+628118751786)
Jl. Diponegoro 69, Jakarta 10430, Indonesia
Tel +62-21-314 8695, 391 7131; Fax +62-21-314 7982
Website: www.eijkman.go.id
E-mail: adhit@eijkman.go.id or sisi@eijkman.go.id

BSL-3 or Biosafety related Experience

Expression of Interest (Max 300

words)

Eijkman Institute for Molecular Biology

The Organizing Committee of BSL-3 Workshop 2016
Contact person: Adit and Sisi (+628118751786)
Jl. Diponegoro 69, Jakarta 10430, Indonesia
Tel +62-21-314 8695, 391 7131; Fax +62-21-314 7982
Website: www.eijkman.go.id
E-mail: adhit@eijkman.go.id or sisi@eijkman.go.id