ECRE AGC 2019

1

Full Name* This field is required.

First Name

Last Name

2

Organisation* This field is required.

3

Country of residence* This field is required.

4

E-mail* This field is required.

5

Do you need a visa to enter Belgium?* This field is required.

YESNO

6

Do you need ECRE to book and pay your travel?* This field is required.We will book trains when possible

YESNO

7

Full Name as it appears on your passport* This field is required.

First Name

Middle Name

Last Name

8

Phone Number* This field is required.

Country Code

Area Code

Phone Number

9

City of departure* This field is required.

10

Arrival date* This field is required.

Date

11

Departure date* This field is required.

Date

12

I will book and pay for my own hotel* This field is required.

YESNO

13

I face serious financial restrictions and would otherwise be unable to participate. I need ECRE to cover my hotel costs.* This field is required.

YESNO

14

From:* This field is required.ECRE to book and pay

Date

15

To:* This field is required.ECRE to book and pay

Date

16

From:* This field is required.I want ECRE to book a room in one of the conference hotels (to be paid by the participant)

Date

17

To:* This field is required.I want ECRE to book a room in one of the conference hotels (to be paid by the participant)

Date

18

I will participate the social event?* This field is required.

YESNO

19

GDPR: Do you agree to submit your information with ECRE for the use of arranging the event / Click on review and submit to complete your registration.* This field is required.

Agree