ANYWHERE Final Workshop - External Organisations Registration Form

ANYWHERE Final Conference (Belgium,29th-30th October 2019)

Please fill this registration form providing details to help the local organisers with the required logistics for the meeting. The fields marked with an asterisk (*) are mandatory.

Your personal information will be treated confidentially and will be deleted after the finalisation of the event.

Personal information

(Please fill in the following fields, using the same data indicated in the ID Card / Passport to avoid problems with transports/accommodation)

Title (*):

First Name(*):

Last Name(*):

Email address (*):

Confirm email address (*):

Institution (*):

Department:

Address:

Zip / Postal Code:

City:

Country (*):

Mobile phone (*):

Organisation profile (*):

Details about your activities in the Workshop

Posters

Are you going to submit a poster? (*): Yes No

Please choose poster category:

WEDNESDAY 30th October:

WEDNESDAY 30th October, Coffee-Break (morning) (*): Yes No

WEDNESDAY 30th October, Coffee-Break (afternoon) (*): Yes No

WEDNESDAY 30th October 2019, Lunch (*): Yes No

My preference for the main course:

Comments on Food Consideration

Miscellaneous

Additional Comments

(*): Hereby I declare that the information provided is correct and that I have read and accepted the terms and conditions.