Registration form - EHC Round Table of Stakeholders on Markets and Access
On Tuesday 3rd December, the European Haemophilia Consortium (EHC) will be holding a Round Table of Stakeholders on 'Markets and Access.' The event will be held at the European Parliament (exact meeting room and timing remain to be confirmed). Please fill in the form here below to register for this event. To find out more information about the EHC Data Privacy policy, please consult the EHC website (www.ehc.eu/data-privacy-policy)
First Name *
Your answer
Last Name *
Your answer
Organisation *
Your answer
Email Address *
Your answer
Do you agree to have your name and organisation on the participants' list, which will be distributed to all participants and uploaded on the EHC website following the event? *
If you are a speaker, do you agree to have your presentation shared with participants on the day and uploaded on the EHC website?
Do you have any dietary restrictions (due to, for e.g. allergies, special diets, religious beliefs, etc.)? *
If you have indicated yes, please let us know what your dietary requirement is:
Your answer
Do you have reduced mobility? *
If you have reduced mobility, will you need a wheelchair to get around in the European Parliament? Please note that this is a large building and that you may need to walk for over 10 minutes to reach the meeting room. (The European Parliament provides free wheelchairs for its visitors, please let us know if you would like to use one during the Round Table)
A photographer will take pictures during the event. These pictures will be used in the EHC's communication material such as, for example, its newsletters, annual reports, website and Facebook Page. Do you agree that the EHC may use pictures of the event in which you appear for its communication material?
Do you have a European Parliament's pass? *
If you are not in possession of a pass to access the European Parliament, please give us the following personal information. This information will be solely used to register you with the European Parliament security services in order to get a speedier access to the premises of the European Parliament.
Date of birth
MM
/
DD
/
YYYY
Nationality
Your answer
Which ID document will you bring to access the European Parliament
Please provide the number of the ID document mentioned in the question above
Your answer
Start validity date of your ID document (the passport or ID card mentioned above)
MM
/
DD
/
YYYY
End validity date of your ID document (the passport or ID card mentioned above)
MM
/
DD
/
YYYY
Your full address (street name and number, zip code, city, country)
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy