EPF Value+ Capacity Building and AGM 2011 - Registration form

 PERSONAL DETAILS
  
Title
  
Surname
  
First Name(s)
  
Job Title
  
Name of the Organisation (in English)
  
Organisation postal address
  
Office phone number
  
Office FAX number
  
Mobile phone number
  
Email
  
Please thick the box if you are eligible for being a young representative
  
Please state any special requirements
  
Other Special Requirements
 TRAVEL
 Participants are invited to make their own travel arrangements in line with EPF policy.
 Transfers from/to airport will not be organised. Further information on travel options from the airport will be sent with final papers.
 ACCOMODATION
 A block booking has been organised on 12 April at the hotel venue.
  
Check in date and time
  
Check out date
  
 The night of the 12 April is payable by the event organisers. Optional supplementary stay at the hotel venue would be at your own expense.
 If you wish staying additional nights, please provide below details of your credit card to enable us making reservation for you.
  
 CREDIT CARD DETAILS TO GUARANTEE ACCOMODATION
Name of cardholder
Card Type / Number
Card expiry date
 ATTENDANCE
  
 Please note that confirmation of attendance at each session/event is required in advance and is payable by the event organisers.
  
Will participate in Value+ Capacity Building and the AGM
  
 I will participate at the open space on Day1 at 19.00
1st choice
2nd choice
Please mention themes you would like to discuss during the open space
  
 I will participate in parallel workshop - Day2 (9.00-10.30)
1st choice
2nd choice
  
 I will participate in parallel workshop - Day 2 (11.00-12.30)
1st choice
2nd choice
  
 I will participate in parallel workshop - Day 2 (13.30-15.00)
1st choice
2nd choice
  
Please mention here themes you would like to discuss in the workshop sessions
  
 Should you encounter any problems, please contact event organisers at events2010@eu-patient.eu