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Online Delegate Registration |
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Here you can register for the Highlights Meeting of the 15th Congress of EHA in the Middle East, you are kindly requested to complete the following pages:
Step 1: Complete personal data
Step 2: Choose payment method
Step 3: Check and finalize your registration
Personal data
Please do NOT register in capitals.
* : required field |
| Family name (printed on badge)* | |
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| Prefix (e.g. van, de la, von) | |
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| Initials (e.g. Maria=M. or Paul=P.)* | |
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| First name (printed on badge)* | |
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| Title (e.g. MD or PhD) | |
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| Gender* | female
male
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| Year of birth | |
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| What is your profession?* | |
| (also required for students and retired doctors) |
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| I spend most of my time in: | |
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| Email address* | |
This e-mail address will be used to confirm your registration
and to send your personal webcast login information. |
Above email address is of the group booker. |
E-mail address will be used to send the delegate
personal webcast login information. |
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| Company / Institute* | |
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| Department | |
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| Address* | |
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| Address (continued) | |
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| Postal / ZIP Code* | |
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| City* | |
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| Country (printed on badge)* | |
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Telephone (without country code)* |
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Fax (without country code) |
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Mobile (without country code) |
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| I graduated in the following year:* | |
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Payment before or Payment after On-site
on September 15, 2010 September 15, 2010 |
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