Faculty logistics arrangements LEUKEMIA 2025 - November 13th

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Title*

Dr.
Prof.
Mr.
Mrs.

Last name*

First name*

Mobile phone number*

Essential to ensure a confortable stay in Paris.
Please do not forget to write your country ID(+33 ; +49 ; +212 ; etc.)

Email address*

Affiliated Medical Center*

Postal Address*

ZIP Code*

City*

Country*

ACCOMMODATION

Hôtel Ibis Style - Paris Bercy*

Night of Thursday, November 13th to 14th
I don't need accomodation

77 Route de Bercy - 75008 Paris, France
Single room, breakfast included.
The Organizing Committee will take in charge 1 night maximum.
All other extras (double room, extra night, minibar, etc.) has to be paid by yourself at the hotel reception desk. Please fill in the "Miscellaneous" box at the bottom of the page.

Transportation*

I will book my transport myself
Book it for me

Departure city*

Departure date*

Departure time*

:

Return city (if different from departure city)

Return date*

Return time*

:

Identity card*

Taille max. des fichiers : 128 MB.

SOCIAL PROGRAM

Presence Days*

I will be here on the 13 of november
I will be here on the 14 of november

Leukemia Gala Dinner on Thursday, November 13th*

Yes, I would like to participate
Yes, I take part to the congress dinner and I will be accompanied by one person (at your charge)
No, I don't want to participate

"Do you have any allergies or specific dietary restrictions?"*

Yes
No

Please specify your dietary restrictions:*

Communication support

Photo*

Taille max. des fichiers : 128 MB.

Please send us a professional photo. This photo will be used as part of our communication campaign on Leukemia social networks and in on-site communication media.

Special request

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.