2024 ALGAL CULTURING COURSE
Application Form (dates have not yet been determined)
Gender (needed for housing assignments). Please
for more information regarding our dormitory.
Street Address Line 2
State / Province
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Cocos (Keeling) Islands
Democratic Republic of the Congo
Turkish Republic of Northern Cyprus
Papua New Guinea
Republic of the Congo
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
Tristan da Cunha
Turks and Caicos Islands
United Arab Emirates
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Please check the course(s) you would like to attend
Algal Culturing Techniques Course (dates have not yet been determined)
Microalgal Mass Culturing Techniques Course (dates have not yet been determined)
Briefly describe your present position and duties
Why are you applying for the course and how will you benefit professionally from attending?
Do you have any special requirements that we need to know about if you are accepted to the course (e.g. allergies to latex gloves, food allergies or special requirements)? We (and our caterer) do our best to ensure all food is labeled appropriately, but recognize we cannot guarantee no cross contamination in a self-serve environment.
Strains of Interest?Do you have a particular strain you are interested in working with? Please let us know and we will do our best to work it into the course.
Please let us know if there is someone at Bigelow you are interested in meeting in person. The research teams are listed on Bigelow’s website at: www.bigelow.org
I enter into this Media Release Agreement with Bigelow Laboratory for Ocean Sciences (Bigelow Laboratory). I authorize Bigelow Laboratory to create recordings of my image, likeness and/or voice (collectively, “Recordings”) in connection with the National Center for Marine Algae and Microbiota (NCMA) Algal Culture Techniques workshops at Bigelow Laboratory. I agree the Recordings may take form of photographs, films, video and audio tapes, CD-ROMs, DVDs, digital files and/or other media of any form now known or later developed. Bigelow Laboratory, at its discretion, may use and allow others to use the Recordings in their original or edited form in any media for any and all educational commercial purposes, and may use and allow others to use my name, image, likeness, voice and biographical, or other information in connection with the Recordings. I understand that use of the Recording may include, but not necessarily be limited to, the following:Internal use at Bigelow Laboratory and the NCMAStreaming in digital format (live or on –demand) on the InternetI further acknowledge that I will not be compensated for any uses made of the Recordings and that Bigelow Laboratory will exclusively own all rights to these Recordings; however, except for the permissions I am granting here, I retain the right I may otherwise hold in copyrighted materials incorporated into the Recordings. I hereby release Bigelow Laboratory from all Claims relating to the use of the Recordings. For this purpose, a “Claim” is any legal proceeding, such as a suit for defamation, invasion of privacy for infringement of copyright. In addition, my release of Bigelow Laboratory includes Bigelow Laboratory itself, as well as Bigelow Laboratory’s officials, employees, representatives, agents, licensees, successors and assigns. I have read and understood the contents of this Release Agreement and I have the right and authority to execute it.
Emergency Contact Information
Emergency Contact Name
Emergency Contact Mobile Number
Emergency Contact Work Number
Emergency Contact Phone Number
Medical Insurance Plan name
Medical Insurance Subscriber Name
Medical Insurance Plan Number
It is agreed and understood not to hold Bigelow Laboratory for Ocean Sciences responsible for any injury occurring to me while I am attending the Algal Culturing Course from April 30 May 9th - 15th, 2020, run by the Provasoli-Guillard National Center for Marine Algae and Microbiota (NCMA), Bigelow Laboratory for Ocean Sciences. In case of accident or serious injury, I hereby authorize Bigelow Laboratory for Ocean Sciences to make whatever arrangements necessary to secure emergency medical care.
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