Registration

Participant

Title before

First name (*)

Surname (*)

Title after

Contact information - fill if you pay the conference fee yourself

Street and No

City

Postal Code

Email

Billing information - fill if the organization will pay the conference fee

Organization

Street and No

City

Postal Code

Identification Number

VAT Number

Participation

PassiveActiveStudent FHS (UTB)

The above personal data is required and shall be processed exclusively for the purpose of subsequent charging of the conference fee. By filing this application I commit to apply to the conference Family - Health - Illness, and confirm that the above data is true and correct. I acknowledge the fact that the conference fee is based on mutual agreement, and that it is nonrefundable (not even partially) even if I do not take part in the conference. I also acknowledge that photographs shall be taken during the conference to be used for its promotion or that of the organizer.

(*) - Required Items

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