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Before filling the form read the rules <b>Regulations</b>. Have any questions? Contact with us via e-mail: <b>21stimclublin@umlub.pl</b>
Before filling the form read the rules
Regulations
. Have any questions? Contact with us via e-mail:
21stimclublin@umlub.pl
Personal Information
Title
Gender
*
MALE
FEMALE
First name
*
Second name
Last name
*
Birthdate
*
mm/dd/yyyy
Address
*
ZIP code
*
City
*
Country
*
Phone number
*
Email
*
Are you Student or Young Doctor ?
*
STUDENT
YOUNG DOCTOR
University
*
MEDICAL UNIVERISTY OF LUBLIN
OTHER
Other University
*
Others
Do you need Visa ?
*
NO
YES
Passport number
*
Do you need the invoice ?
*
NO
YES
Data for invoice ?
*
Diet
*
NORMAL
VEGETARIAN
OTHER, TYPE BELOW
Diet Other
*
Banquet
*
NO
YES
Would you be interested in taking part in a club party the day before the conference (05.04.2019) ?
*
NO
YES
Would you be interested in booking accommodation in Cent Hostel ?
*
NO
YES (05-07.04.2019)
YES (other date)
Date from
*
04/05/2019
mm/dd/yyyy
Date to
*
04/07/2019
mm/dd/yyyy
A person who told you about the Congress or how did you find out about the Congress ?
Abstract 1 (required)
Abstract 1 Session
(abstract guidelines)
*
ORAL SESSION
POSTER SESSION
Abstract 1 Title of work
*
Abstract 1 Departament / Research group
*
Abstract 1 Authors
*
Abstract 1 Supervisor
*
Abstract 1 Abstract
*
Abstract 1 Keywords
*
Abstract 2 (not required)
Abstract 2 Session
*
ADD / DELETE
ORAL SESSION
POSTER SESSION
Abstract 2 Title
*
Abstract 2 Departament / Research group
*
Abstract 2 Authors
*
Abstract 2 Supervisors
*
Abstract 2 bstract
*
Abstract 2 Keywords
*
Abstract 3 (not required)
Abstract 3 Session
*
ADD / DELETE
ORAL SESSION
POSTER SESSION
Abstract 3 Title
*
Abstract 3 Departament / Research group
*
Abstract 3 Authors
*
Abstract 3 Supervisors
*
Abstract 3 Abstract
*
Abstract 3 Keywords
*
In case the participant would want to present three scientific papers,
an additional payment occurs in the amount of 50 PLN.
Regulations
General regulations
*
Rules on the provide of personal data
*
Rules on plans for the use of personal data
*
Rules on the use and distribution of materials with my image by the Medical University of Lublin
*
Rules on the provide of optional multimedia materials
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