Registration Type of participation: Doctor/Embryologist Cluster Member “National Center for Research, Education and Monitoring Fertility Problems” Personal data: Name Surname Phone number E-mail Business data: Profession number Position Company name/Institution Address (Street and house number) City Postal code Country Tax identification number Type of participation: Early Bird - until 20th of Febuary 2020. Price: 850PLN / 200 EUR 2 turns - from 21th of Febuary until 30th of March 2020 Price: 1050 PLN / 250 EUR 3 turns - from 31th of March 2020 Price: 1200 PLN / 300 EUR Cluster Member “National Center for Research, Education and Monitoring Fertility Problems” Price: 850PLN / 200 EUR Gala Dinner + Live Music Performance* 17 IV 2020 Social event will be at: 20:00, friday, 17 IV 2020 (after the meritoric programme) I'll participate in social event (Gala Dinner + Live Music performance) which is extra paid. Price: 250 PLN / +70 EUR *social event is not financed from the funds of innovative companies associated in Infarma The basic Participant fee includes: - Identity card and conference materials, - Admission to Scientific sessions, - Admisssion to medical exhibition, - Lunch 17 April 2020 - Coffe breaks provided for in the program, - Participation certificate. The conference participant with the paid fee has also the opportunity to register for selected free workshops (the number of participants is limited, therefore it will be first come first served). Invoice: I want to receive a VAT invoice Payment method: Bank transfer: Data needed to make a bank transfer: Account number: 4816 0014 6218 8639 4510 0000 01 International account number: IBAN: PL48 1600 1462 1886 3945 1000 0001 BIC Code: PPABPLPK Bank Account Holder: Association for Improvement Contemporary Diagnostic Methods and Infertility Treatment "Child" Comments: Registration is required for all Conference participants. Regular and student registration fee includes attendance to all lectures, coffee breaks and lunch. Accommodation is not included. Consents and statements* Social event: dinner + live music* *social event is not financed from the funds of innovative companies associated in Infarma I declare that I have read and accept the content of the conference regulations I hereby agree to the processing of my personal data by the organizers: National Center for Research, Education and Monitoring Fertility Issues and 4OpenMind to the extent necessary to organize a series of events, in accordance with the Act of August 29, 1997 on the protection of personal data (consolidated text, Journal of Laws of 2016, item 922). At the same time, I am aware that the event can be photographed and can be filmed videos recording the course of the event and I hereby agree to use my image in such materials for the purpose of event promotion. I understand that I have the right to inspect my personal data and correct it. I agree to the processing of my personal data by the Organizers of Development of Scientific Cooperation in Reproductive Medicine Research: National Center for Research, Education and Monitoring Fertility Problems and 4OpenMind, for marketing and statistical purposes in accordance with the provisions of the Act of August 29, 1997 on the protection of personal data (consolidated text, Journal of Laws of 2016, item 922). The administrator of personal data is the Association for the Improvement of Contemporary Methods of Diagnosis and Treatment of Infertility "Dziecko" KRS: 0000098209, NIP: 5422369380, REGON: 050257740. Terms
