Your browser does not support javascript. This is required for using the requested form.
Registration form
PhD Advanced Course Infection and Immunity, LUMC
19 - 30
January 2026
Initials:
*
First name:
*
Prefix (e.g. van, van den):
Last name:
*
Date of birth:
*
dd/mm/yyyy
University / Organisation:
*
Department:
*
Working address:
*
Email:
*
Mobile phone number:
*
Internal or external student:
Internal (course fee € 350,00)
External (course fee € 450,00)
Cost center:
*
Project code (if applicable):
Starting date PhD (if applicable):
dd/mm/yyyy
I herewith declare that my supervisor agrees
with my participation in this course:
*
*
=
Input is required