PLEASE NOTE: only fill out if your group would like to use the Leica DMI6000 B within the next three months!!!
Name of lab head:*
E-Mail:*
Telephone:*
Department :*
Address:*
Address lab:*
Publications with confocal:

Names of people in the group that will receive the fiest training (max.3):

	Name	Phone	Email
1.
2.
3.

Do they have experience with widefield microscopy?      Yes  /  No 
If so, what was done and which widefield was used (short)?

Please note: First training session is mandatory and will cost Euro 300, -. Each additional training session will cost the same. The trained people will have to train the other lab members. Each individual also has to register and fill out the first time user form to obtain a username and password for reservation of widefield time via the CMMC website. If unregistered non-trained people are found working with the widefield, the whole group will no longer be allowed to work at the Leica DMI6000 B. The same sanction will be put into place if people work at the widefield without reserving time online.

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I hereby consent to the processing of my personal data for registration for the symposium. This consent can be revoked at any time. Further information can be found in the data protection declaration.