Registration profile
Physician/Medical Doctor
Company Partners/ Sponsor (included in sponsorship agreement)
Sponsor / partner
Personal data
First Name
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Last Name
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Phone
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E-mail
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Country
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Afghanistan
Albania
Algeria
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Angola
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Samoa
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Slovenia
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Sudan
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Sweden
Switzerland
Syria
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Venezuela
Vietnam
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Business data
Position
Workplace
Country
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Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia And Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Congo Democratic Republic
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Holy See
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar Burma
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Republic of the Marshall Islands
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad And Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Specialization
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Licence number
Payment summary
Payment method
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Bank transfer
Invoice data
Type of Payer
Company / Institution
Individual
Company name
*
Address
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Post code
*
City
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Country *
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Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia And Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Congo Democratic Republic
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Holy See
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar Burma
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Republic of the Marshall Islands
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad And Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
VAT ID No.
*
Other e-mail to send invoices
Comments
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I have read and accept the regulations of participation in events organized by OnLabel Konsulting available on the website 3602Aneurysm.pl/regulamin.
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I hereby consent to the processing of my personal data by OnLabel Konsulting, 54-104 Wrocław, ul. Kozia 55/1, NIP: 8941210432, REGON 369630028, to the extent necessary for the purposes of organizing this event.
INFORMATION CLAUSE REGARDING THE PERSONAL DATA PROTECTION ACT:
In accordance with Article 13(1)(a) of the GDPR, we inform you that the administrator of your personal data processed in connection with the organization of the educational and conference event understood as a course, symposium, conference, meeting, or congress is OnLabel Konsulting, with its registered office in Wrocław at Kozia 55/1, 54-104. The administrator has appointed a Data Protection Officer, whom you can contact regarding all matters related to the processing of your personal data via email at: biuro@onlabel.pl (Article 13(1)(b) GDPR).
The collected personal data are processed for the purpose of organizing your participation in the event, verifying attendance, settling fees related to participation, printing badges, and issuing participation certificates (Article 13(1)(c) GDPR). Providing personal data is required to ensure participation in the conference. Failure to provide data will result in the inability to participate in the conference. Providing data required for issuing a VAT invoice is a legal requirement for proper invoicing. Failure to provide these data will result in the inability to issue a VAT invoice to you (Article 13(2)(e)).
Recipients of your personal data are entities providing services to the administrator based on data processing agreements, including: the hotel, the printing house preparing certificates, external accounting services, and persons providing registration services for the conference under a relevant and time-limited agreement (Article 13(1)(e) GDPR).
Your data will be stored indefinitely. You have the right to withdraw your consent at any time (Article 13(2)(a) GDPR). In accordance with Article 13(2)(b) GDPR, you have the right to request access to your data, their rectification, deletion or restriction of processing, and the right to withdraw your consent to personal data processing at any time without affecting the lawfulness of processing based on consent before its withdrawal (Article 13(2)(c) GDPR)
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Please pay for your participation by bank transfer immediately after registering and no later than within the next 3 days. In the event of non-payment, the Organizer reserves the right to remove you from the list of participants and launch additional registration. I have read and accept the conditions of participation/withdrawal from participation in the event.
I consent to the processing of my personal data for marketing and commercial purposes by OnLabel Konsulting with its registered office in Wrocław, ul. Kozia 55/1, 54-104 Wrocław, NIP 8941210432, REGON 369630028. At any time, withdrawal of consent with the content NIE is possible by e-mail to the following address: biuro@onlabel.pl
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