Course Intent to Apply Form Please send it back by email to Valentina EMILIANI : [email protected] Applicant: Title………………………………………. First Name…………………………….. Last Name……………………………… Gender…………………………………… Affiliation/Organization……………………………….. ………………………………………………………………………. Department…………………………………………………... City………………………………………………………………… Country…………………………………………………………. Email………..………………………………………………….... Lab head First name………………………………………. Last name ……………………………………….. How did you learn about the course? ……………………………………………………………………… Brief statement of interest (400 word max) Optical control of brain functioning with optogenetics and wave front shaping

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Page 1: cnrsformation.cnrs.frcnrsformation.cnrs.fr/data/STG_18269_15520.docx · Web view400 word max) Author Valentina Emiliani Created Date 11/03/2017 07:35:00 Last modified by Utilisateur

Course Intent to Apply Form

Please send it back by email to Valentina EMILIANI : [email protected]

Applicant:Title……………………………………….First Name……………………………..Last Name………………………………Gender……………………………………

Affiliation/Organization………………………………..……………………………………………………………………….Department…………………………………………………...City…………………………………………………………………Country………………………………………………………….Email………..…………………………………………………....

Lab headFirst name……………………………………….Last name ………………………………………..

How did you learn about the course?………………………………………………………………………

Brief statement of interest (400 word max)

Optical control of brain functioning with optogenetics and wave front shaping

mailto:[email protected]