Registration for HOPE Representatives – HOPE Agora

Please read first the instructions on the registration page

Registration for HOPE Representatives

Personal information

Title *

First name *

Surname *

Organisation *

Address *Street + number

Postcode *

City *

Country *

Email *

Phone *Country code + number

Dietary requirements *

HOPE meetings and conferences

HOPE meetings - NOT FOR HOST ORGANISATIONS

Please indicate the meetings you will attend

Board of GovernorsMeeting of the Liaison OfficersMeeting of the National Coordinators

Conferences

Please indicate the conferences you will attend *

I will attend the Conference on Polish healthcare on MondayI will attend the Exchange Evaluation Conference on Tuesday

Evening events

Please indicate the evening events you will attend *

I will attend the welcome party on MondayI will attend the farewell party on Tuesday

Questions?

Please write here the questions you might have

Payment

Declaration

*

By submitting this registration form the HOPE representative commits himself to pay the fee of €300 for HOPE Agora Warsaw (hotel excluded) before 30 April 2015. THE BANK ACCOUNT DETAILS WILL BE SENT WITH THE AUTOMATIC CONFIRMATION OF THIS REGISTRATION. The registration fee is non-refundable in case of cancellation within 10 days before the start of the HOPE Agora or in case of no-show.I agree

Verification

Please enter any two digits *Example: 12
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