CONFERENCE / ENROLLMENT FORM

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CONFERENCE / ENROLLMENT FORM

OFOR PROFESSIONALS IN THE FIELD OF HAEMATOLOGY

DATE: March 23rd, 2024, from 8:45AM to 5:30PM

VENUE: Lumen Hotel & The Lisbon Light Show - Rua Sousa Martins, nº 20, 1050-217 Lisbon

COSTS: participation is free, registration is mandatory by submitting this fully completed registration form.

Feel free to contact APCL for any further question: geral@apcl.pt

An event supported by

Name *

E-mail *

Cell phone number

I'm a
*

Doctor

Researcher

Health professional

Pharmaceutical industry professional

Other:

Please insert your Healthcare License Number.
*

Will you have your lunch at the hotel venue? Lunch is free for all those who enroll in the conference. *

Yes

INFORMED CONSENT

I authorize the collection of images from me, during the day of the event, and their dissemination by APCL on its communication channels such as social networks and website. I also authorize this disclosure by APCL to be made in any form, without temporal or territorial limits.

I know that I will not receive any rights or compensation for the use of the collected materials.

NOTE: For legal purposes it is necessary to enter the citizen's identification number. *

YES, I AUTHORIZE

Citizen's identification number *

I authorize my data to be used to send me information regarding other activities carried out by APCL. *

YES, I AUTHORIZE (my data will never be provided to third parties)

NO (my data will be deleted shortly after this event takes place)

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