Registration profile

Physician

Industry

Student

Nurse, Technician, Paramedic

Physician from Jagiellonian University Medical College

Registration with code

Personal data

Gender

Male Female

First Name *

Last Name *

Tax Office *

Work place

Date of birth *

VAT ID number (pesel) *

Phone *

E-mail *

Confirm e-mail *

Street Address *

Postal code *

City *

Province *

Additional data

Company name

Affiliation (Hospital/Institute/University)

Place of work (Clinical Department) *

Medical Practitioner Number

Accommodation

I'd like to book a room

HOTEL BB

Accommodation type

Price per night

Hotel Hilton Garden Inn Kraków

Accommodation type

Price per night

Choice of accommodation

Single room

Twin room

Triple room

Length of stay

Stay from

Stay to

Additional information

Workshops

13.12 godz. 14:45-16:45

14.12 godz. 13:15 – 15:15

13.12 godz. 15:30 - 18:00

15.12 godz. 12:00 - 15:00

13.12 godz. 12:45 - 14:45

14.12 godz. 15:00 - 17:00

Payment summary

Chosen currency

Payment method

Invoice data

Type of Payer

Company / Institution

Individual

Company name *

Address *

Post code *

City *

Country *

VAT ID No. *

Other e-mail to send invoices

Comments

* I hereby declare that the above-mentioned number of occupation is true, i.e. I have the right to practise as a doctor, which is not restricted or suspended in any way, and thus, advertisements of medicinal products may be addressed to me as a person entitled to issue prescriptions in accordance with the Regulation of the Minister of Health of 21.11.2008 on the advertising of medicinal products.

* I hereby give consent for my personal data to be processed for the purposes of organizing the NFIC conference and providing the conference materials. I am aware that providing personal data is voluntary, but necessary for the purposes for which it was collected.

Herewith I confirm that I am a registered physician and my work is related to interventional cardiology.