Registration for the EIPEN 2017 Conference

After registering onnline, you will receive an invoice by sending an e-mail to info@eipen.eu
When registering after March 15th, please wait to pay untill you have received the invoice.

Have you attended an EIPEN Conference recently (after 2010)?
 
Do you plan to submit an abstract for the 2017 Conference (or have you already submitted one)?
 
I have read (and agree with) the terms for payment of registration fees on the EIPEN website.
 
Family name (e.g., Beecher-Stowe)
 
First name (e.g., Harriet)
 
Institutional affiliation (e.g., University of Medirail)
 
City and Country (e.g., Carranay, France)
 
E-mail address
 
Title (Ms, Mr, Dr, Prof...)
 
Academic degree (PhD, MD, Master, Bachelor)
 
Date of today (DDMMYY)
 
Any remarks to handle your registration correctly:
 
Address for invoicing:
 
Membership status
 
I am a staff member of an institution that is member of EIPEN
I am an individual supportive member of EIPEN
I am not yet a member but subscribe a membership (for at least 3 years) now
I am not an EIPEN member, and nor is my institution
When do you plan to be in Lausanne City? (The conference starts at 4pm)
 
On Wednesday Sep 6th before 4pm
On Wednesday Sep 6th between 4 and 8pm
On Wednesday Sep 6th between after 8pm
On Thursday Sep 7th
When do you plan to leave the conference?
 
On Thursday evening
On Friday morning
On Friday afternoon
Do you plan to attend the Cocktail walking dinner on the first evening? (included in the registration fee)
 
Yes
No
I will depend on the situation
Do you plan to attend the Conference dinner on the second evening? (included in the registration fee)
 
Yes
No
It will depend on the situation
Do you have any dietary restrictions or preferences?
 
Vegetarian
Gluten-free
Lactose-free
Sugar-restricted