SIB Embedded Bioinformatician application

Embedded Bioinformatician information
Gender *

Gender Male Female
Name *

First Last
Birth date *

/ DD / MM YYYY
Employer (university, institution, etc...) *
End date of employment contract *

/ DD / MM YYYY
Laboratory's name *
Name of Laboratory's Director *
Office name/number
Professional address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Office phone *
Office fax
Professional email address (on which the SIB one will be redirected) *
Private email address (will be used in case of problem with the professional address) *
Information on the collaboration with SIB
SIB Group Leader's name *

First Last
SIB group's name *
Starting date of collaboration *

/ DD / MM YYYY
End date of collaboration (if known)

/ DD / MM YYYY
Please give a brief description of the collaboration with the SIB's group *
Please insert a good quality portrait of yourself, of at least 142 x 95 pixels (height x width) for our web directory *

Attach Files Attach Files
Signatures
E-bioinformatician:
Place and date
Laboratory's Director
Place and date
SIB Group Leader
Place and date
Submission instructions:

PLEASE PRINT OUT THIS FORM BEFORE SUBMITTING US THE ELECTRONIC VERSION.
THEN SEND US A SCANNED VERSION WITH THE REQUIRED SIGNATURES BY EMAIL
TO: Sylvie.Flegel@sib.swiss
OR A PAPER VERSION AT THE FOLLOWING ADDRESS:
Sylvie Flegel
SIB Swiss Institute of Bioinformatics
Quartier Unil-Sorge, bâtiment Génopode
1015 Lausanne
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In the number 84657, what is the 5th digit?

SIB Embedded Bioinformatician application

SIB Embedded Bioinformatician application

Embedded Bioinformatician information

Information on the collaboration with SIB

Signatures

Submission instructions: