Fundacja Rozwoju Neonatologii

Registration form

Personal data

Name (required)

Surname (required)

E-mail (required)

Profession

Medical specialization

Contact data

Workplace/Institution

Address (required)

Phone number (required)

Participation in social dinner on 29, November 2019 (additionally paid)

yesno


Invoice

yesno


Payer's name/Sponsor

Payer's address

VAT number

Workshops:

not interestedWorkshops 1 - ResuscitationWorkshops 2 - High flow therapyWorkshops 3 - Cerebral oxygenation monitoring (NIRS)Workshops 4 - aEEG applications in the neonatal unitWorkshops 5 - Closed loop FiO2



(required) I hereby give consent for my personal data included in the registration form to be processed by Poznan University of Medical Sciences for the purposes of of the registration process necessary for the organization of the Symposium.


I hereby give consent for my personal data included in the registration form to be processed by Poznan University of Medical Sciences for the purpose of informing me via e-mail or post of future conferences and courses.




Fees

1. Registration fees:
– 250 PLN (60 EUR)/participant

The registration fee includes:

  • Opening Ceremony and Welcome Reception,
  • Attendance to all scientific sessions,
  • Delegate’s bag,
  • Entrance to exhibition,
  • Lunches according to the program,
  • Certificate of attendance.

2. Dinner fee:
– 50 PLN (15 EUR)/participant

"Participation in dinner is additionally paid by participants and is not financed from the funds of innovative companies associated in INFARMA".


Fundacja Rozwoju Neonatologii w Wielkopolsce
ul. Polna 33, 60-535 Poznań

Nr konta 41 1160 2202 0000 0000 6089 1331
Bank Millenium SA

The data administrator is Poznan University of Medical Sciences at the address: ul. Fredry 10, 61-701 Poznań, Poland. The data will be processed in order to carry out the registration process necessary for the organization of the Symposium and after giving additional consent also for the purpose of sending information about future conferences and courses via e-mail and telephone. Providing data is voluntary, although it is necessary for the above-mentioned purpose to be achieved. Any person providing their data has the right to access, correct and delete it. The contact person is the Information Security Administrator at Poznan University of Medical Sciences (abi.ump@ump.edu.pl). The duration of data storage and the legal basis are specified, among others by Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (general regulation on data protection).