| Which course would you like to register for? |
| Dates | Level I Level II |
| Personal details: |
| Title (Dr, Miss etc.) | |
| Name | |
| Nationality | |
| Business Address | |
| Telephone | |
| Fax | |
| Email Address | |
| CPD Registered | Yes No |
| Lab coat size | |
| Please submit a purchase order with your registration form to the value of the registration fee (plus VAT), attach a VAT exemption certificate if applicable. |
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| Accomodation |
| A single room will be booked for you at a local Hotel starting the evening before the course start date. Departure will be the morning of the last day. (This is not included in the course fees.) |
| Do you require extra nights at the hotel? | Yes No |
| If Yes, please specify | |
| Do you have any special dietary requirements? | Yes No |
| If Yes, please specify | |
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| The series of questions below will enable us to modify the course in some areas to meet your needs therefore we would appreciate your answers. However we cannot guarantee to cover all your specific needs. |
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| 1. | Give a brief description of your relevant scientific qualifications and experience: | | |
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| 2. | Which of the areas below best describes your current job? | | Research Production Quality Control Administration |
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| 3. | How much experience have you had working with cell cultures? | | Other please specify |
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| 4. Please indicate the experience you have of the following cell culture techniques |
| Working aseptically in a Class II cabinet | |
| Subculturing attached cells | |
| Subculturing suspension cells | |
| Resuscitating vials of frozen cells | |
| Cryopreserving cells | |
| Using a haemocytometer for manual cell counting | |
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| 5. | Which cells and types of cell cultures do you have experience of? | | Primary Cells Organ cultures Hybridomas
Suspension cells Attached cells 3D culture
Large scale cell preparation
What cells are you currently working with? |
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| 6. | Which cells would you like to work with on the course? | | |
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| 7. Do you have any objections to observing practical demonstrations showing the preparation of cells from: |
| Human umbilical cord | Yes No |
| Rat cerebella | Yes No |
| Chick embryo's | Yes No |
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| 8. | Please give a short reason and statement why you would like to attend this course. | | |
| Important Notice - Before making your travel arrangements it is advisable to contact ECACC one month prior to the course date to ensure the course is proceeding. Cancellations - If you cancel your registration 4 weeks or more before the course date a �75.00 administration fee will be deducted from your refund. If less than 4 weeks notice is given we can only refund 50% of the total course fee. |