OCEANIC-STROKE Steering Committee Meeting - Registration

OCEANIC-STROKE Steering Committee Meeting - Registration - November 2nd, 2024

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

Full Name - Enter your name as shown on your identification.
Title
First Name*
Middle Name
Surname 1*
Surname 2
Birth Date

MonthDayYear
Gender
Country of Issue
Institution*
Name Badge
Name as preferred on Badge
Contact information
Mobile Phone*
Business Phone*
Extension
Your Email*
Travel Information
Transportation*
Airport or Rail Station of Departure*
Preferred Airline
Frequent Flyer#
Arrival Date*
Preferred Arrival Time
Departure Date*
Preferred Departure Time
Preferred Seating
Accommodations
Do you require Hotel Accomodation?*
Accommodation will be provided at InterContinental Lisbon Hotel for the nights of November 1st and November 2nd, 2024. (Extra nights are avilable at your own expense).
Will you require any additional nights?

If so, please specify:
Check in Date
Check out Date
Will you be attending the Welcome Dinner on November 1st, 2024?*

YesNo
Dietary Restrictions or Allergies
Additional Information
Should be Empty:

Accommodations