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Registration form
PhD Advanced Course Infection and Immunity, LUMC
18 - 29
January 2027
Initials:
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First name:
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Prefix (e.g. van, van den):
Last name:
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Date of birth:
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dd/mm/yyyy
University / Organisation:
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Department:
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Working address:
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Email:
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Mobile phone number:
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Internal or external student:
Internal (course fee € 350,00)
External (course fee € 700,00)
Cost center:
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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:
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