Application Form
(to be confirmed and sighed by the head of the relevant department / division of the applying organization)

To the Director of the RIKEN BioResource Research Center (RIKEN BRC)

 Applicant information
Full Name (as in the passport)      Last/Family  First  Middle

Sex:  Male  Female                                    	Nationality:	
Date of Birth:                                  dd / mm / yyyy	
Organization:
	
Department / Division:
	
Present Position:
	
Address 	
TEL:	E-mail:	
Date:	Signature:	

 Our organization hereby applies for Technical training course for ICSI (intracytoplasmic sperm injection) of mice  provided by RIKEN BioResource Research Center (RIKEN BRC) and proposes to dispatch the above person to participate in the following Training Course.

Theme: Technical training course for ICSI (intracytoplasmic sperm injection) of mice 
Place: BioResource Research Center main building, RIKEN Tsukuba Campus
Date: From November 25 to 27, 2019   3 consecutive days 

Responsible person
Name:	
Designation / Position	
Department / Division	
Office Address and 
Contact Information	Address:

	TEL:

	FAX:
	E-mail:
	
Date:	Signature:	
Agreement: As a trainee at RIKEN, the applicant hereby agrees to abide by the following provisions.
1.  All rights concerning research results (including tangible research materials) produced or obtained in the process of the training course shall, in principle, belong to RIKEN.
2.  The trainee must not disclose information obtained or acquired in the process of the training course at RIKEN (except for handouts and explanatory information).
3  RIKEN shall not be held liable for any injury or damage that the trainee suffers or that the trainee causes a third party during the training course without any fault attribute to RIKEN. When the trainee has caused damage to RIKEN either intentionally or by gross negligence, compensation for the total or partial cost of the damage may be imposed on the applying organization.