Attending G-CHF Study Team - Amsterdam, November 2023

Glad to hear you are attending G-CHF Study Team

Amsterdam
Please complete this form and click Submit.
* indicates a required field

Full Name - Enter your name exactly as shown on your valid passport
Title
First Name*
Middle Name
Surname 1*
Surname 2
Birth Date*

MonthDayYear
Gender*
Institution*
Name Badge*
Name as preferred on Badge
Study Position Title*
Country*
I am a Member of COLT-HF Steering Committee and will attend the meeting on November 4th:*

YesNo
I am a Member of BRAVE Steering Committee and will attend the meeting on November 5th:*

YesNo
Contact information
Mobile Phone*
Business Phone*
Extension
Your Email*
Travel Information

IMPORTANT: Please check with your local consulate representing The Netherlands to confirm if you require a Schengen visa. PHRI will supply an invitation letter confirming your attendance and, if required Heming Group can provide you with a hotel confirmation and copy of airline ticket. It is your responsibility to arrange your visa appointments if necessary. Please retain all receipts and you will be reimbursed for costs associated with obtaining your Schengen visa.
Transportation*
City or Airport of Departure*
Preferred Airline
Frequent Flyer#
Arrival Date*

MonthDayYear
Preferred Arrival Time
Preferred Seating
Departure Date*

MonthDayYear
Preferred Departure Time
Accommodations
Do you require Hotel Accomodation?*
Accommodation will be provided at the Amsterdam Hilton for Nov 3 and 4 (Nov 5 if required due to flight scheduling) (Extra nights may be available at your own expense).
If YES, completion of dates below are REQUIRED.
Check in Date

MonthDayYear
Check out Date

MonthDayYear
Are you attending the welcome dinner on Friday November 3?*

YesNo
Are you attending the dinner on Saturday November 4?*

YesNo
Dietary Restrictions or Allergies
Additional Information
Should be Empty:

Glad to hear you are attending G-CHF Study Team

Accommodations