CX 2018 Faculty Confirmation
Participation Confirmation and Accommodation Booking Form
Name
*
Prefix
First Name
Last Name
Telephone Number (day contact number):
*
-
Country code
Phone Number
Email Address
*
example@example.com
WORKSTATION: I confirm my participation in the CX 2018 Venous Workshop
*
Yes
No, I am unable to participate, please explain
Why are you unable to participate?
ACCOMMODATION: I understand that CX will provide me with accommodation as advised previously, single occupancy, at a CX 2018 hotel (allocated by the CX organizers):
*
Yes, I require accommodation
No, I do not require accommodation
I require a Double Occupancy room and agree to pay the difference in cost
I require accommodation for additional night/s and agree to pay the difference in cost
Other
Check In Date
-
Month
-
Day
Year
Date
Check Out Date
-
Month
-
Day
Year
Date
CX is hosting a '40 Years of Looking Forward' reception on Thursday, 26 April. The reception will take place at the Science Museum from 7pm:
*
Yes, I am able to attend
No, I am unable to attend
Type a question
Submit
Should be Empty: