A quarter century after the direct and

indirect pathways model of the basal ganglia

and beyond

Open till September 1st, 2014

BG2014 Registration

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1.Your name and affiliation

Name:
  【e.g. Taro Shinkei】
氏名(Name in Japanes)
  【日本人の方は漢字表記もお願いします 例:神経 太郎】
Your affiliation
 (e.g. Division of System Neurophysiology, National Institute for Physiological Sciences)
Job title  (e.g. professor, postdoctoral fellow, PhD student)
Your e-mail address:
Your e-mail address (again):
Your address (includes postal code):


   (e.g. 38 Nishigonaka, Myodaiji, Okazaki, 444-8585, JAPAN)
Your phone number: e.g.0564-55-XXXX (ext.YYYY)
Your FAX number:

2.Poster presentation

Presenting your poster is preferable.
Yes, I would like to present my poster.
The title of my poster:

3. Dinner with poster presentations and discussions Highly recommended! (是非参加!)

 Yes, I would like to participate (it will cost 3,000-4,000JPY).

4.Lodge reservation

 I would like to stay in a room of Mishima Lodge (2,500-2,700JPY per night).
 I would like to reserve a hotel room by myself.[Find a hotel room]
 Neither

5.Travel grant

 Yes, I would like to apply for travel grant.
Presenting your poster is preferable.
years

6.WiFi

 Yes, I would like to use WiFi in NIPS.

7.Further information and requests

For any further requests for changes,
please send e-mail to "BG2014@nips.ac.jp"

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