• Family name*
• First name*
• E-mail address*
• Cell phone number*
• Your medical center*
• City*
• Country*
  AFGHANISTANALAND ISLANDSALBANIAALGERIAAMERICAN SAMOAANDORRAANGOLAANGUILLAANTARCTICAANTIGUA AND BARBUDAARGENTINAARMENIAARUBAAUSTRALIAAUSTRIAAZERBAIJANBAHAMASBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBERMUDABHUTANBOLIVIABOSNIA AND HERZEGOVINABOTSWANABOUVET ISLANDBRAZILBRITISH INDIAN OCEAN TERRITORYBRUNEI DARUSSALAMBULGARIABURKINA FASOBURUNDICAMBODIACAMEROONCANADACAPE VERDECAYMAN ISLANDSCENTRAL AFRICAN REPUBLICCHADCHILECHINACHRISTMAS ISLANDCOCOS (KEELING) ISLANDSCOLOMBIACOMOROSCONGOCOSTA RICACOTE D'IVOIRECROATIACUBACYPRUSCZECH REPUBLICDENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICECUADOREGYPTEL SALVADOREQUATORIAL GUINEAERITREAESTONIAETHIOPIAFALKLAND ISLANDS (MALVINAS)FAROE ISLANDSFEDERATED STATES OF MOLDOVAFIJIFINLANDFRANCEFRENCH GUIANAFRENCH POLYNESIAFRENCH SOUTHERN TERRITORIESGABONGAMBIAGEORGIAGERMANYGHANAGIBRALTARGREECEGREENLANDGRENADAGUADELOUPEGUAMGUATEMALAGUERNSEYGUINEAGUINEA-BISSAUGUYANAHAITIHEARD ISLAND AND MCDONALD ISLANDSHOLY SEE (VATICAN CITY STATE)HONDURASHONG KONGHUNGARYICELANDINDIAINDONESIAIRANISLAMIC REPUBLIC OF IRAQIRELANDISLE OF MANISRAELITALYJAMAICAJAPANJERSEYJORDANKAZAKHSTANKENYAKIRIBATIKOREAKUWAITKYRGYZSTANLAO PEOPLE'S DEMOCRATIC REPUBLICLATVIALEBANONLESOTHOLIBERIALIBYAN ARAB JAMAHIRIYALIECHTENSTEINLITHUANIALUXEMBOURGMACAOMACEDONIAMALAWIMALAYSIAMALDIVESMALIMALTAMARSHALL ISLANDSMARTINIQUEMAURITANIAMAURITIUSMAYOTTEMEXICOMICRONESIAREPUBLIC OF MONACOMONGOLIAMONTENEGROMONTSERRATMOROCCOMOZAMBIQUEMYANMARNAMIBIANAURUNEPALNETHERLANDSNETHERLANDS ANTILLESNEW CALEDONIANEW ZEALANDNICARAGUANIGERNIGERIANIUENORFOLK ISLANDNORTHERN MARIANA ISLANDSNORWAYOMANPAKISTANPALAUPALESTINIAN TERRITORYPANAMAPAPUA NEW GUINEAPARAGUAYPERUPHILIPPINESPITCAIRNPOLANDPORTUGALPUERTO RICOREPUBLIC OF MADAGASCARREPUBLIC OF KOSOVOREUNIONROMANIARUSSIAN FEDERATIONRWANDAQATARSAINT BARTHÉLEMYSAINT HELENASAINT KITTS AND NEVISSAINT LUCIASAINT MARTINSAINT PIERRE AND MIQUELONSAINT VINCENT AND THE GRENADINESSAMOASAN MARINOSAO TOME AND PRINCIPESAUDI ARABIASENEGALSERBIASEYCHELLESSIERRA LEONESINGAPORESLOVAKIASLOVENIASOLOMON ISLANDSSOMALIASOUTH AFRICASOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDSSPAINSRI LANKASUDANSURINAMESVALBARD AND JAN MAYENSWAZILANDSWEDENSWITZERLANDSYRIAN ARAB REPUBLICTAIWANTAJIKISTANTANZANIATHAILANDTHE DEMOCRATIC REPUBLIC OF THE COOK ISLANDSTHE FORMER YUGOSLAVTIMOR-LESTETOGOTOKELAUTONGATRINIDAD AND TOBAGOTUNISIATURKEYTURKMENISTANTURKS AND CAICOS ISLANDSTUVALUUGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMUNITED STATESUNITED STATES MINOR OUTLYING ISLANDSURUGUAYUZBEKISTANVANUATUVENEZUELAVIET NAMVIRGIN ISLANDS, BRITISHVIRGIN ISLANDS, U.S.WALLIS AND FUTUNAWESTERN SAHARAYEMENZAMBIAZIMBABWE

• Accommodation

• Single room, breakfast included. The organizing committee covers a maximum of 2 nights. The extra and added night will be charged to you. If you need a double room, please keep us informed in the “special requests” below.*
  • Night of February 27th (27th to 28th, first day of the congress)
  • Night of February 28th (28th to March 1st)
  • I don't need accommodation
  Single room, breakfast included. The organizing committee covers a maximum of 2 nights. The extra and added night will be charged to you. If you need a double room, please keep us informed in the “special requests” below.
• Special accommodation requests

• Transport

• IMPORTANT INFORMATION
  

For organizational purposes and because the flight ticket prices evolve really quickly, we kindly ask you to confirm your acceptance of our travel proposal by Friday, December 17th. If we do not receive your confirmation by then, we will invite you to book your tickets on your own, which we will reimburse post event based on the amounts stated above.
Thank you for your understanding.

*

• Yes, I would like you to 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...)

Download your passport or ID Card*

Taille max. des fichiers : 128 MB.

Essential to book your travel. Thanks.

Thank you for sending your receipts and your bank details after the congress to :
Com&Co Events
Lucille Sarafian
15 Bd Grawitz - 13016 Marseille
Or by email to : registration-fya@comnco.com
We will proceed with your refund via bank transfer within 4 weeks, for a maximum amount of €450. If you use your personal vehicle, The refund allowances will be calculated based on a standard kilometer reference, using Mappy.

Special travel requests

Social Program

CONGRESS DINNER : February 28th*

• Yes, I take part to the congress dinner
• No, I do not take part to congress dinner

Personnal Data Policy

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.

Name

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