Registration

APPLICATION FORM

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

PassivePractitioner (KNTB)

Information about the contribution - to be filled in only by active participants

Author of the Paper

Co-authors of the Paper (max. 2)

Post Title (CZ, SK, PL)

Post Title (EN)

Brief Annotation (max. 2-3 lines)

Form of Presentation
LecturePoster

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