IMC LIVE 2019 : I BUY MY PACKAGE KSA IMC LIVE 2019 : I BUY MY PACKAGE KSA https://form.comnco.net/wp-content/uploads/2018/06/IMCLIVE.png 1175 653 Com&Guest Com&Guest https://form.comnco.net/wp-content/uploads/2018/06/IMCLIVE.png 6 juin 2018 7 novembre 2018 I BUY MY PACKAGE KSA - IMC LIVE 2019 * field mandatory Degree*Family name*First name*E-mail address*Affiliated Medical Center*City*Country*Date of birth*Cell phone number*RegistrationI register as :* Physician Fellow Other Other (please indicate your speciality) :How many CTO PCI did you personally perform during 2018 ?*How many CTO PCI do you consider personally to perform this year?*Did you participate to the previous IMC LIVE Edition in 2018?* Yes No How have you heard about the IMC LIVE?* Newsletter Website (browser) Brochure Industry Other Other (please specify)*What are the reasons why you want to attend this Conference ?*AccommodationSelect the night(s) according to your package ONLY 2 NIGHTS Night of January 16th (16th to 17th, day before the congress) Night of January 17th (17th to 18th) Night of January 18th (18th to 19th) I don't need accommodation Single room, breakfast included. The extra and added night will be charged to you (and has to be paid directly to the Hotel). If you need a double room (charged to you), please keep us informed in the part below. If you will be accompanied by one person (15€).Special accommodation requestsTransportAirport tranfers will be handled by the organization. You will receive detailed information in your travel book few days before your departure by email.Yes, I would like you to make my travel arrangementsNo, I will make my own travel arrangementsUpload your Bank IDTypes de fichiers acceptés : jpeg, jpg, png, pdf, gif.Mandatory to pay off your travel.Departure city*Departure dateSelect your time slot for your departureOn morningOn afternoonOn eveningReturn city (if it is not departure city)Return dateSelect your time slot for your returnOn morningOn afternoonOn eveningMembership card type and number (airline, railroad company...)Preffered Airline companyUpload your passport or ID Card*Types de fichiers acceptés : jpeg, jpg, png, pdf, gif.Mandatory to book your travel.Special travel requests (aisle, window...)Social ProgramSOCIAL Dinner : Thursday, January 17th Yes, I take part to the gala dinner I will be accompanied by one person (70€) No, I do not take part to the gala dinner Sans titreSans titrePremier choixDeuxième choixTroisième choixEmailCe champ n’est utilisé qu’à des fins de validation et devrait rester inchangé.