BIMC 2018 - Registration

Registration
1. Personal and Contact Information
First Name * :
Last Name * :
Date of birth * :
E-mail * :
Phone number:
Country of origin * :
Nationality * :
ID/Passport number(if you need a visa):
2. Education
Status * :
Student
PhD Student
Year of Study * :
University * :
Faculty * :
3. Other information
If you would like to receive a VAT invoice, please fill this field with adequate information (Name/Full University Name, VAT Identification Number, Address, City, Zip code)
VAT Invoice Data:
Do you need a visa? * :
Yes
No
4. Terms of Participation
Terms of Participation * :
Passive
Active
Clause * :In accordance with art. 24 par. 1 of the Act of 29 August 1997. on Personal Data Protection (i.e. from 2015. Item. 2135, as amended. D) we inform that:
1) the administrator of your data is the Rector of Medical University of Bialystok, seated in ul. Kilińskiego 1, 15-089 Bialystok,
2) the data is collected in order to register for the conference and will not be shared with other entities,
3) you have the right to access your personal data and correct it,
4) data submission is voluntary.
In accordance with art. 23 par. 1 pt. 1 of the Act of 29 August 1997. on Personal Data Protection (i.e., from 2015. Item. 2135, as amended. D), I hereby agree to the processing of my personal data in order to register for the conference.