V4RM Network registration form

Full name of organization (team):*

Logo of organization:
Maximum file size 10MB. Allowed file format is pdf, jpg, png, tif, ai, gif, esp*

Country:*

Czech Republic Hungary Poland Slovakia Ukraine

Type of organization:*

Research laboratory/institution Academic/educational organization Enterprise

Full mailing address of organization:*

Website:

Brief description (up to 200 words) of the team and activities:*

Number of people in the team:*

Less than 5 5–10 10–20 20–50 50–100

Contact / responsible person details:

Full name, including academic titles*

Position*

Institutional email*

I agree to publish my contact details on the V4RM.net website*

I agree I do NOT agree

I agree with terms and conditions*

Terms and conditions

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All fields marked with an asterisk (*) are mandatory.

Contacts

Institute of Experimental Medicine CAS
Vídeňská 1083
142 20 Praha 4–Krč
Czech Republic