General information

Name:*
Telephone:*
Institution:*
Department:*
Telephone (Department):*
Invoice e-mail:*
You will receive the invoice on this e-mail address
Invoice address:*
Country:*
E-mail:*
A confirmation mail will be sent to this e-mail address
Do you wish to use EAN:
Be aware of an administration fee of DKK 100,-
EAN number:*
Payment address:*
Contact person:**
CVR number

Participant







Other information

I will submit an abstract:* Yes
No
I intend to participate in the dinner Monday
Tuesday
I wish to be considered for The Junior Brain Prize:* Yes
No
For more information about The Junior Brain Prize, see The Brain Prize Meeting 2017 Programme
*Deadline for registration and submission of abstract: 10 October 2017

Payment terms

You will within a few weeks receive an invoice from Lundbeckfonden. Net sum upon receipt of invoice to:

Reg. no.: 3100
Account no.: 3120 108 565

Outside of Denmark, please use:
SWIFT : DABADKKK
IBAN: DK75 3000 3120 1085 65.

Please make sure that your payment has been processed.
If we haven't received your payment before 27 October 2017, your registration will be cancelled.

IMPORTANT! Please make reference to: 'The Brain Prize Meeting' and provide your name when making the payment.

Scherfigsvej 7
2100 Copenhagen Ø
Denmark
Tel. +45 39 12 80 00
CVR-nr. 11 81 49 13
info@thebrainprize.org
www.thebrainprize.org
Nils Axelsen Ralf Hemmingsen Lauritz Holm-Nielsen Ralf Hemmingsen Jens Oddershede Jens Frederik Rehfeld Anders Bjørklund