IMC LIVE 2022 : Faculty member logistic arrangements

Degree*

Dr
Prof.
Mr
Mrs

Family name*

First name*

E-mail address*

City*

Country*

Job title*

Affiliated Medical Center*

Mobile phone number*

Please do not forget to write your country dialling code (+33 ; +49 ; +212 ; etc.)

VISA APPLICATION

To access Jeddah (KSA), will you need a visa ?*

Yes
No

Please upload your CV below*

Taille max. des fichiers : 128 MB.

Please upload your scanned passport below /!\ 2 first full pages in JPEG (IMAGE FORMAT) - PDF not accepted*

Taille max. des fichiers : 128 MB.

Please upload your scanned ID photo below*

Taille max. des fichiers : 128 MB.

Please upload below your VISA INFO SHEET filled*

Taille max. des fichiers : 128 MB.

Please download the VISA INFO SHEET template document here and join it in the field above

ACCOMMODATION

Select the night(s) you wish to stay at the Hotel*

Night of March, Tuesday 15th (15th to 16th, day before the congress)
Night of March, Wednesday 16th (16th to 17th)
Night of March, Thursday 17th (17th to 18th)
I don't need accommodation

Single room, breakfast included.
The Organizing Committee will take charge of 3 nights maximum.
Any extras and added night will be at your charge (and has to be paid directly to the Hotel). If you need a double room, please fill out the tab below.

Special accommodation requests

TRANSPORTATION

Airport transfers will be handled by the organization.
If you wish for a specific transfer service, please contact directly the taxi transfer agency so that they can proceed directly with payment.
If you wish to make your own travel arrangements, please make sure to let us know your travel details.

Yes, I would like you to make my travel arrangements
No, I will make my own travel arrangements

Upload your Bank ID*

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

Mandatory to pay off your travel.
/!\ Please find below the amount of reimbursement depending on your country :
- USD 5 000,00 for Japan and USA
- USD 1 500,00 for Europe and Asia
- USD 1 000,00 for Africa
- USD 600,00 for Middle East
- USD 300,00 for Saudi Arabia

/!\ PLEASE NOTE THAT ONCE YOUR FLIGHTS TICKETS ARE BOOKED, NO CHANGES OR REFUNDS ARE POSSIBLE.

Departure country*

Departure city*

Departure date*

Departure time*

Morning

Afternoon

Evening

Return country (if it is not departure country)

Return city (if it is not departure city)

Return date*

Return time (departure from Jeddah)*

Morning

Afternoon

Evening

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

Upload your passport or ID Card*
Types de fichiers acceptés : jpeg, jpg, png, pdf, gif, Taille max. des fichiers : 128 MB.
Mandatory to book your travel.

Will you need a checked luggage ?*

Yes, please

No, thank you

Special travel requests (aisle, window...)

SOCIAL PROGRAM

Congress Dinner - March 16th*

Yes, I take part to the congress dinner

Yes, I take part to the congress dinner & I will be accompanied by one person (EUR 70,00)

No, I do not take part to the congress dinner
* restaurant TBA

Personal data*

By sending this form, I agree that my personal data might be used for the purposes of my logistic arrangements by the company or any service providers that may need it.

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

IMC LIVE 2022 : Faculty member logistic arrangements