Personal data

Gender *

Male Female

First Name *

Last Name *

Title *

Phone *

E-mail *

Country *

Business data

Workplace *

Street Address

Post code

City

Country

Licence number *

Accommodation

I'd like to book a room

Hotel HOLIDAY INN****

Description

Accommodation type

Price per night

PARK Hotel***

Accommodation type

Price per night

Choice of accommodation

Single room

Twin room

Triple room

Length of stay

Stay from

Stay to

Additional information

Additional options

I will take part in the General Meeting of the Transfusiology Section on 2/09/2021 r.

I will take part in the General Meeting of PTHiT on 3/09/2021

I will take part in the Opening Gala on 2/09/2021

I will take part in supper on 3/09/2021

I will take a course for laboratory diagnostics as part of continuous training titled "Haematological diagnostics in 2021"

Payment summary

Payment method

Invoice data

Type of Payer

Company / Institution

Individual

Company name *

Address *

Post code *

City *

Country *

VAT ID No. *

Other e-mail to send invoices

Comments

* I give my consent to the processing of personal data that I will disclose and of my image by Anna Wacławek trading under the name of Anna Wacławek Eleven Agency, ul. Gandhi 35/255, 02-776 Warsaw, taxpayer identification number (NIP): 6641812516, Statistical ID (REGON): 142712928, acting as the Data Controller, for contact purposes connected with my registration and the submission of information or documents (e.g. certificates) in order to enable my participation in the 24th Conference of the Polish Society of Hematologists and Transfusionists, including in particular the verification and confirmation of my attendance at the Conference.

I also give my consent to receiving a newsletter and commercial information and to the processing of my personal data by Anna Wacławek, trading under the name of Anna Wacławek Eleven Agency, ul. Gandhi 35-255, 02-776 Warsaw, taxpayer identification number (NIP): 6641812516, Statistical ID (REGON): 142712928, acting as the Data Controller in relation to my personal data that I will disclose, in order to inform me about future conferences, scientific actions and accompanying projects conducted by the Data Controller.

* I certify that I have given the above consent(s) voluntarily and that before giving the consent(s) I have been informed that I have the right to withdraw my consent at any time. I certify that I am aware that the withdrawal of my consent is without prejudice to the lawfulness of data processing performed on the basis of the consent before such withdrawal.

* I certify that I have familiarised myself with the information clause of the Data Controller, which is available below

Additional registrants

Name *

Surname *

E-mail *

Confirmation of registration

Send registration confirmations:

of all registrants to the first registrant only

of all registrants to the first registrant and individually to the others

to each registrant individually

First registrant will receive registration confirmations of all registrants to the e-mail address entered in the first section of the form. Other registrants will not receive any e-mail confirmation (which might include payment information).

Registration profile