Title:
Name:
Surname:
E-mail:
Phone:
Accompanying Person name:
Poster
Poster Presentation :
If checked, enter the title of the poster:
Invoice data
Institution/Company:
Country:
City:
Street:
Zip code:
TAX number:
ECTN-member Institution:
Social Events
Welcome Reception (included in the fee):
Welcome Reception - Accompanying Person (extra paid 25 EUR):
Dinner (included in the fee):
Dinner - Accompanying Person (extra paid 45 EUR):
Guided tour of the new building of the Faculty of Chemistry (Sunday, after lunch, ca. 30-45 min.):
Visiting the Museum of the Jagiellonian University (before/during Welcome Reception):
Guided Krakow sightseeing tour Friday, at 14:00:	OR	Guided Krakow sightseeing tour Sunday, at 16:00:
Arrival on (YYYY-MM-DD):
Departure on (YYYY-MM-DD):
I hereby give consent for my personal data to be processed in matters pertaining to: name, surname, title, affiliation, e-mail and professional address for the purposes of registration at ECTN Krakow GA 2019 and preparation of conference materials in accordance with the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 with regard to the processing of personal data and in accordance with the information clause.