Registration

Step 1 of 8

12%

How would you like to participate at CMLHZ24?(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)

MM slash DD slash YYYY

Passport expiry date(Required)

MM slash DD slash YYYY

Date of birth(Required)

MM slash DD slash YYYY

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)

MM slash DD slash YYYY

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

Yes

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

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

MM slash DD slash YYYY

Any dietary requirements?

Please state

Would you like to participate in the city tour?(Required)

Yes

Would you join us for Friday dinner?(Required)

Yes

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

Yes

Will you be travelling with a companion?(Required)

Yes

(Please take note that your companion will need to pay for a Double Room surcharge of €12 per night direct to the hotel. In addition to this if they accompany you to dinner on Friday night will be a surcharge of €65.00 and on Saturday €70.00)

Companion First Name(Required)

Companion Last Name(Required)

I am interested in displaying a poster(Required)

Yes

IN-PERSON REGISTRATION FORM - Steering committee member

First Name as written in passport(Required)

Last Name as written in passport(Required)

Title(Required)

Passport number(Required)

Passport issue date(Required)

MM slash DD slash YYYY

Passport expiry date(Required)

MM slash DD slash YYYY

Date of birth(Required)

MM slash DD slash YYYY

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)

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

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

MM slash DD slash YYYY

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

Yes

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

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

MM slash DD slash YYYY

Any dietary requirements?

Please state

Would you like to participate in the city tour?

Yes

Would you join us for Friday dinner?(Required)

Yes

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

Yes

Will you be travelling with a companion?(Required)

Yes

Companion First Name(Required)

Companion Last Name(Required)

I am interested in displaying a poster

Yes

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)

MM slash DD slash YYYY

Passport expiry date(Required)

MM slash DD slash YYYY

Date of birth(Required)

MM slash DD slash YYYY

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)

MM slash DD slash YYYY

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

Yes

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

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

MM slash DD slash YYYY

Any dietary requirements?

Please state

Would you like to participate in the city tour?

Yes

Would you join us for Friday dinner?(Required)

Yes

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

Yes

Will you be travelling with a companion?(Required)

Yes

Companion First Name(Required)

Companion Last Name(Required)

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)

Yes

Any dietary requirements?

Please state

Would you like to participate in the city tour?

Yes

Would you join us for Friday dinner?(Required)

Yes

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

Yes

Will you be travelling with a companion?(Required)

Yes

Companion First Name(Required)

Companion Last Name(Required)

VIRTUAL REGISTRATION FORM

First Name(Required)

Last Name(Required)

Email Address(Required)

Mobile No.(Required)

Country where your patient organisation is located(Required)

Are you a(Required)

Name of the Patient Organization you are representing(Required)

The position you represent within your Patient Organization(Required)

Name of the Pharma Company you are representing(Required)

The position you represent within your Pharma Company(Required)

Regional meetings will be held during the month of October virtually via zoom; please confirm you will attend your regional meeting

Yes

I am interested in displaying a poster

Yes

Registration

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

Agenda