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

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