USEFUL INFORMATION

CONTACT INFORMATION

Fields marked with * are required.

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Last name

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First name

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Job title

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Email address

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Confirm your email

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Phone number
Cellphone

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Why do we need your mobile phone number? Late-breaking information: program changes, etc.
Commitment to not communicate your number to a third party.

Numéro RPPS
Department
Specialty

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Hospital / University / Organization
Street address

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ZIP / Postal code

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City

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Country

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Day 1 Thursday March 28th

Welcome buffet
12:00 PM - 01:10 PM

Networking Evening - Dinner
07:30 PM - 09:30 PM - 60 €

Special diet

ACCOMODATION

I would like to receive a list of possible hotels.

REGISTRATION

Guest code
  Early bird fees* Regular fees*
200 € 230 €
250 € 280 €
20 € 30 €
* Early bird fees: until February 11th, 2019.
** Regular fees: after February 11th, 2019.
*** Please note that your registration will be confirmed only upon reception of your justify document.

PAIEMENT METHODS

Personne en charge du dossier d'inscription

Prénom et Nom

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E-mail

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Confirmez votre e-mail

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Téléphone

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Service

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Adresse de facturation différente de l'adresse de l'inscrit

Adresse de facturation

Nom de l'établissement

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Adresse

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Boîte postale
Code postal

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Ville

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No refund after February 25th, 2019. 40 € will be charged before this date except for students.
 Any additional message