21st Century Medicine - International Medical Congress

Active Participant

Before filling the form read the rules Regulations. Have any questions? Contact with us via e-mail: 21stimclublin@umlub.pl

Personal Information

Title

Gender *

First name *

Second name

Last name *

Birthdate *

mm/dd/yyyy

Address *

ZIP code *

City *

Country *

Phone number *

Email *

Are you Student or Young Doctor ? *

University *

Others

Do you need Visa ? *

Do you need the invoice ? *

Diet *

Banquet *

Would you be interested in taking part in a club party the day before the conference (05.04.2019) ? *

Would you be interested in booking accommodation in Cent Hostel ? *

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) *

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 *

Abstract 3 (not required)

Abstract 3 Session *

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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