ELEC 2024 - Logistics support for Faculty member - March 21st to 23rd

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 March, 20th (20th to 21st)
Night of March, 21st (21st to 22nd)
Night of March, 22nd (22nd to 23rd)
I don't need accommodation

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

Special accommodation requests

TRANSPORT

Airport and/or station tranfers 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, I would like for you to book my transport
No, I will book my own transport and be reimbursed

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...)

We will reimburse you up to :
– France : 500€
– Europe (out of France) : 750€
– Out of Europe : 2000€
Please send your receipts and your bank details after the course to : registration@elec-ir.com We will proceed to your refund by bank transfer within 4 weeks after the conference depending of your departure country. If you use your personal vehicle, the allowances of refund will be calculated on a standard kilometers referral.

SOCIAL PROGRAM

Faculty Dinner - Thursday, March 22nd*

Yes, I take part to the faculty dinner
No, I do not take part to the faculty dinner

ELEC Dinner - Friday, March 23rd*

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

GDPR*

I certify that I am a healthcare professional.

GDPR*

By clicking on 'Send', I confirm that I have read and understood our Privacy Policy and consent to the processing of my personal data by COM&CO EVENTS, in accordance with the said Policy, in order to best respond to my registration request.

I authorize that my personal data be transmitted to the industrial partners participating in the event, for exclusively professional purposes.

Phone

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

ELEC 2024 – Logistics support for Faculty member – March 21st to 23rd