GATE (VIPERLAB)

Registration

Please complete the following form to register for VIPERLAB GATE. At the end there are several documents that have to be acknowledged. In most cases, acknowledgment is a prerequisite for a successful registration.

Fields marked with * are required.

Account

Username *

Password * (min. 6 characters, case sensitive)

Password (again) *

Personal information

Email *

Title

Family name *

Birth name

Given name *

Please provide your complete name (including given name, second name(s) / middle name(s) and family name) as written in your passport / identity card. *
This information is needed by both the HZB Radiation Protection Office and the HZB Security Office.

Birthday (Day, Month, Year)*

Place of birth *

Citizenship *

Additional citizenship (if applicable)

Gender *

male female diverse

Status *

Facilities of interest

VIPERLAB

Please choose your
scientific preference(s): *1.
2.
3.

Affiliation (employer)

Organisation/Institute *

Department *

Street

ZIP / City * /

ZIP / PO. Box /

Country *

Phone *

Fax

Infomail *

I would like to receive information by email on call for proposals, call for reports, user meetings, ...

yes no

Acknowledgement *

Privacy Policy of VIPERLAB-GATE