ECC 2022 - Faculty | Com&Co Form

Family name*

First name*

E-mail address*

Cell phone number*

Cell phone number (only) Please indicate in front of your phone number, the country dialling code of your country.

Affiliated Medical Center*

Country*

City*

N° RPPS (only for french physician)*

If you do not have an RPPS number, please note in this section "N/A".

YOUR CV

Upload your CV

Types de fichiers acceptés : jpeg, jpg, png, pdf, gif, Taille max. des fichiers : 128 MB.

ACCOMMODATION

Select the night(s) according to your wishes*

Night of June, 22nd (22nd to 23rd)
Night of June, 23rd (23rd to 24th)
I don't need accommodation

This package includes a single room for two nights at the hotel.

Special accommodation requests

TRANSPORT

Airport and/or station transfers will be handled by the organization. You will receive detailed information in your travel book few days before your departure by email.

Do you need a transportation booking?*

Yes, please make my travel arrangements
No ,I will make my own travel arrangements

Departure city*

Departure date*

Departure time*

Morning
Afternoon
Evening

Return city (if it is not departure city)

Return date*

Return time*

Morning
Afternoon
Evening

Membership card type and number (airline, railroad company...)

Preferred Airline company

Upload your passport or ID Card*

Types de fichiers acceptés : jpeg, jpg, png, pdf, gif, Taille max. des fichiers : 128 MB.

Essential to book your travel. Thanks.

Special travel requests (aisle, window...)

SOCIAL PROGRAM

ECC Dinner - Thursday, June 23rd at 8PM*

Yes, I take part to the gala dinner
I will be accompanied by one person (60€)
No, I do not take part to the gala dinner

Comments

Ce champ n’est utilisé qu’à des fins de validation et devrait rester inchangé.

ECC 2022 – Faculty

ECC 2022 - Logistics support for Faculty Member

YOUR CV

ACCOMMODATION

TRANSPORT

SOCIAL PROGRAM

CONTACT

ECC Registration