Registration form

To register, please send a completed application form and pay the registration fee by the indicated date.

Due to mandatory invoicing through KSeF, please ensure your billing details are correct.
No changes can be made after the invoice has been issued.

Participant information

Salutation *

First name *

Last name *

Academic title

Medicine license no

Phone *

E-mail *

Participant type *

Social events

Get-together Party (172 PLN)

Address

City

Zip code

Country

Institution

Institution *

Department *

Street *

Zip code *

City *

Phone

Invoicing data

Number of invoices

One Two

Applicant

Individual
Company

Company name or surname *

Street *

Zip code *

City *

Tax identification number / VAT number

Applicant

Individual
Company

Company name or surname *

Street *

Zip code *

City *

Tax identification number / VAT number

Order summary

Total amount

Additional information

I hereby consent to receiving commercial information regarding products and services offered by Sponsors, at the email address and phone number I have provided, for the purpose of delivering educational and marketing materials following the training, in accordance with the Act of 18 July 2002 on the provision of electronic services.