CBC Course Registration Form Cephalopod Research Cephalopod Biology and Care Course Program, now also embraching fishes (marine) FELASA CBC: for the increase of animal welfare and to facilitate the use of minimally-invasive techniquesPersonal InformationTitle *Please selectMr.Mrs.MissMs.Dr.Prof.OtherFirst Name *Last Name *Gender *Please selectMaleFemalePrefer not to sayOrganization *Department *Address Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryE-mail Address *Telephone n. (include +area code) *If yes, which cephalopod species Academic Training *Please selectMedicineBiologyVeterinary medicineNone of the aboveLegal requirements In case your Academic Training is not easily identifiable in the list, or whether you have doubts and to confirm your eligibility, please upload a file including the complete list of all relevant courses (including BSc studies and/or their equivalent) that you followed, and the number of hours they took. This information will give us the possibility to verify your qualifications, and those required to be registered in the Course (file format allowed: png; jpeg; tiff; tif; doc; docx; pdf).Experience with laboratory animals *Please selectYesNoIf yes, which species (please list separating each with semi-colon) Experience with cephalopods *Please selectYesNoExperience with Fish *Please selectYesNoIf yes, please list fish species CBC Course Program is designed to provide full training including e.g., lectures, case study/problem-based learning (PBL), student’s presentations, seminars/tutorials, practical hands-on training. CBC Training Program is designed around the “Working document on the development of a common education and training framework to fulfil the requirements under the Directive 2010/63/EU”, and includes: Core Modules; Function Specific Modules (functions A, C and D). Originally designed around Cephalopod biology and care and for cephalopod species-specific training, the new editions are now expanding to meet species that share the Biota, i.e. marine fish as the sole other species included in the Directive 2010/63/EU that live at sea. Course Registration Fee - Full: 1000.00 euro; Single Taxon: 800 euro Full course registration fee is intended for those that would like to acquire training on both taxa (cephalopods & marine fish); ‘single taxon’ is intended for Trainees interested in either cephalopods or marine fish.Administrative informationDate of birth * Place of birth (city and country)City: *Country *Address of residence Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryCitizenship *National Identification Number / Security Number / Fiscal Code: *Preferred e-mail contact *Special Dietary Requirements (if any) Registration Fee *Please selectCourse Registration Fee CBC (cephs only)Course Registration Fee CBC (fish only)Course Registration Fee CBC (combined)Payment Method *Please selectCredit cardBank transferInvoicing *Please selectVAT InvoiceNo VAT Invoice (Receipt in compliance with fiscal rules) CBC Training Program – INTRODUCTORY SURVEY1. Is the use of cephalopods and/or fish for research purposes, regulated by any law in EU? *YesNoDon't know2. Do you know if the use of cephalopods and/or fish for research purposes is regulated by any law in your country? *YesNoDon't knowPlease indicate the country where you work: *3. Is your areas of expertise related with animal welfare? *YesNoDon't know4. Have you have any experience with animal welfare (any species not necessarily cephalopods)? *YesNoDon't knowIf yes, please describe it briefly below 5. Are you currently using cephalopods or fish in your projects or daily activity? *YesNoDon't Know6. If yes is the answer to question #5: which species and which biological system (e.g., nervous system, cardiovascular, camouflage) are you working on? [please list] 7. How do you picked-up CBC Training Program? and/or Who pointed us to you? *8. Do you know of any other course delivering similar information running or active in your country or any other? If yes, where, please provide info. *9. Why are you interested to CBC Training Program? *10. Have you ever attended a CBC course before? *YesNo11. Have you ever attended a training program on cephalopods or fish before? *YesNoIf yes, please describe it briefly below 12. Which are your expectations for attending CBC Course? *13. How do you think you would be able to use experience you’ll get from this course? *Thank you for your time! This short survey will help us understanding why you have come to the course, and provide some information to be able to target future courses. It is part of a continuous link between the course program and Trainees. Data Processing Consent Data Controller: Association for Cephalopod Research ‘CephRes’ ETSPersonal Information: we collect personal information that you choose to provide during your registration to the CBC Course.Uses & Sharing:We use your information to process your registration application and to communicate with you about this course and related events. Your name, identity and citizenship/country may be included in the list of participants posted at the event. We temporarily provide personal information to companies that perform services to us and require them to protect your information in the same way we do.Data SecurityWe take commercially reasonable steps to protect your information from loss, misuse, and unauthorized access. When personal information is transferred over the Internet, we encrypt it using Transfer Layer Security (TLS) encryption technology or similar technology.Your Rights: You have the right to receive the information we hold about you, ask to correct it or, under certain circumstances, to delete it.Contact us: Inquiries regarding data protection can be directed to our Data Protection Office (DPO) via email (rd_innovation@cephalopodresearch.org) or by post to: Data Protection, Association for Cephalopod Research ‘CephRes’ ETSRampe Brancaccio 4980132 Napoli, ItalyGDPR terms and conditions *I accept and allow you to use my data Please enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>: