Title *: |
|
|
First name *: |
|
|
Middle name: |
|
|
Last name *: |
|
|
Position / function *: |
|
|
Company / organization *: |
|
|
Division / department: |
|
|
Website: |
|
|
Address 1 *: |
|
|
Address 2: |
|
|
City *: |
|
|
State: Required for U.S. and Canada |
|
|
Zip / postcode *: |
|
|
Country / Territory *: |
|
|
Phone *: |
|
Please complete using the international format ( +33 (0)1 11 11 11 11 for France, +1 (111) 111-1111 for US...) |
Fax: |
|
Please complete as indicated above. |
Mobile phone: |
|
Please complete as indicated above. |
E-mail *: |
|
E-mail addresses will be used to identify registrants. If you are registering several people from your company / division, please complete this form with the e-mail address of each registrant. |
Confirm e-mail *: |
|
|
Other information to be included on your invoice: |
|
For example: VAT number, Company legal ID number, ... |
Affiliation *: |
|
|
Do you wish to present a poster:
|
|
|
How did you hear about this meeting: |
|
|
Additional comments: Please let us know if you have any special needs or dietary requirements:
|
|
|
Payment *: |
Online
Offline / Wire transfer
|
If you have a complimentary registration (sepaker, sponsor or student) please select "Offline payment" |
Complimentary membership: |
|
- I accept an IABS complimentary membership for the current year and following year. The membership will become effective after participation in a meeting.
- I understand that this complimentary membership will offer me access to all meeting documents
- Voting right: I also understand that this complimentary membership does not entitle me to vote in any IABS election. |
|
If you want to benefit from a complimentary membership, please provide us with the following details:
I would like to become a member of the following affiliate:
|
|
|
|
|
Consent form |
|
By checking this box, I agree to receive electronic communication(s) from IABS and its affiliates regarding meetings, webinars, projects, membership information, and other IABS / IABS-EU activities of interest.
If you no longer wish to receive communications from us, you can unsubscribe from our information at any time by sending an email to iabs@iabs.org |
|
|
By checking this box, I accept that my personal data will be collected and archived for a limited period of time following the webinar / meeting for statistical purposes.
You have the right to access, rectify or delete your personal data by contacting iabs@iabs.org |
I accept the General Conditions of Sale*: |
|
click here to see the General Conditions of Sale |
Please enter the following code *: |
|
Case sensitive ! |