Please choose one of the panel discussions you would like to attend* *
Do you have a specific topic, which you would like to address within an individual presentation? (Please summarise it in 3-5 sentences) *
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Date of birth *
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Postal code *
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Address *
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Country *
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Email address *
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Phone number *
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Please specify your motivation to take part at the activity
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Please let us know if you have a special diet as a vegetarian for medical or religious reasons (for example diabetics, any food allergy, fast, Muslim) because we will need to order your meal in advance accordingly. *
Can your email address be shared with participants of this meeting? *
By returning this form I approve that organisers stores and uses my information as reference. *
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