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Course Intent to Apply Form

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

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

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

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Brief statement of interest (400 word max)

Optical control of brain functioning with optogenetics and wave front shaping

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