Registration

How would you like to participate at CMLHZ22?(Required)

In-person

Virtually

You are registering as(Required)

CML Advocates Network member

Steering committee member

Speaker

Representing a sponsor

Two

IN-PERSON REGISTRATION FORM - CML Advocates Network member

First Name as written in passport(Required)

Last Name as written in passport(Required)

Title(Required)

Passport number(Required)

Passport issue date(Required)

Passport expiry date(Required)

Date of birth(Required)

Nationality(Required)

How would you like your name to appear on the name tag?(Required)

Country where you live?(Required)

Email Address(Required)

Mobile No.(Required)

Name of the Patient Organization you are representing(Required)

The position you represent within your Patient Organization(Required)

Are you(Required)

Which city would you like to depart from?(Required)

What date would you like to travel from your origin city?(Required)

Would you like to use CML AN shuttle service from the airport to the conference venue and back again?(Required)

Which destination city would you like to return to?(Required)

Which date would you like to return to your destination?(Required)

Any dietary requirements?

Please specify:

Would you like to participate in the city tour?

Yes

No

Would you join us for Friday dinner?(Required)

Yes

No

Would you join us for Saturday off-site dinner?(Required)

Yes

No

Will you be travelling with a companion?(Required)

Yes

No

(Please take note that your companion will need to pay for a Double Room surcharge of $20 per night direct to the hotel) In addition to this if they accompany you to dinner on Friday night will be a surcharge of $60.00 and on Saturday $70.00

Companion First Name

Companion Last Name

I am interested in displaying a poster

Yes

No

IN-PERSON REGISTRATION FORM - Speaker

First Name as written in passport(Required)

Last Name as written in passport(Required)

Title(Required)

Passport number(Required)

Passport issue date(Required)

Passport expiry date(Required)

Date of birth(Required)

Nationality(Required)

How would you like your name to appear on the name tag?(Required)

Country where you live?(Required)

Email Address(Required)

Mobile No.(Required)

Which city would you like to depart from?(Required)

What date would you like to travel from your origin city?(Required)

Would you like to use CML AN shuttle service from the airport to the conference venue and back again?(Required)

Which destination city would you like to return to?(Required)

Which date would you like to return to your destination?(Required)

Any dietary requirements?

Please specify:

Would you like to participate in the city tour?

Yes

No

Would you join us for Friday dinner?(Required)

Yes

No

Would you join us for Saturday off-site dinner?(Required)

Yes

No

Will you be travelling with a companion?(Required)

Yes

No

(Please take note that your companion will need to pay for a Double Room surcharge of $20 per night direct to the hotel) In addition to this if they accompany you to dinner on Friday night will be a surcharge of $60.00 and on Saturday $70.00

Companion First Name

Companion Last Name

IN-PERSON REGISTRATION FORM - Sponsor

First Name(Required)

Last Name(Required)

Name of the Company you are representing(Required)

The position you represent within your Company(Required)

Title(Required)

Country where you live?(Required)

How would you like your name to appear on the name tag?(Required)

Email Address(Required)

Mobile No.(Required)

Would you like to use CML AN shuttle service from the airport to the conference venue and back again?(Required)

Any dietary requirements?

Please specify:

Would you like to participate in the city tour?

Yes

No

Would you join us for Friday dinner?(Required)

Yes

No

Would you join us for Saturday off-site dinner?(Required)

Yes

No

Will you be travelling with a companion?(Required)

Yes

No

(Please take note that your companion will need to pay for a Double Room surcharge of $20 per night direct to the hotel) In addition to this if they accompany you to dinner on Friday night will be a surcharge of $60.00 and on Saturday $70.00

Companion First Name

Companion Last Name

In order to allow us to book your room and arrange transfers if needed, please email us as soon as possible your flights details to Marrakesh and back.

VIRTUAL REGISTRATION FORM

First Name(Required)

Last Name(Required)

Email Address(Required)

Mobile No.(Required)

Name of the Patient Organization you are representing(Required)

Country where your patient organisation is located(Required)

The position you represent within your Patient Organization(Required)

Are you a(Required)

IN-PERSON REGISTRATION FORM - CML Advocates Network member

IN-PERSON REGISTRATION FORM - Steering committee member

IN-PERSON REGISTRATION FORM - Speaker

IN-PERSON REGISTRATION FORM - Sponsor

VIRTUAL REGISTRATION FORM

Registration