Dubai Harvard Foundation for Medical Research

REGISTRATION FORM

The Fourth Annual DHFMR Scientific Conference

“Partners in Research”
Tuesday, November 17th, 2009

9:30 am – 5:00 pm, Grand Hyatt Dubai, UAE

Registration Instructions: To submit your registration application, please fill in the registration form below. (Please note that all fields are required.) Should you have any problems registering, please contact the Conference Office at dhfmr@hms.harvard.edu.

Registration Deadline: November 12, 2009

Confirmation: Please allow up to 7 days for confirmation of your registration.

Title:
First name:
Middle initial:
Last Name:
Institution / University:
Department:
Position:
Academic degrees:
Address:
City:
State / Country:
Telephone:
Fax:
Email address:

Please describe your research background and activities (maximum 500 words):

Please allow up to 7 days for confirmation of your registration.