Registration

Please fill in the form and confirm by clicking "Continue".
If you have any further questions please contact Conventus at (e-mail registration@conventus.de).

If you require hotel accommodation or more information about the conference, please refer to the congress website: https://dzif-peg-annual-meeting.de/.

We recommend to take out your own seminar cancellation insurance to cover the financial risks of cancellation costs.

Please note: For security reasons the form you are presently using will automatically be interrupted and reset after 20 minutes. To guarantee and protect your information the entire online Registration form is encrypted with SHA (256 BIT).

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Personal Data

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Participant Type*

Regular
Student/PhD student

Regular

Student/PhD student

Gender

Degree

First Name*

Last Name*

Tax id

CME

Possible certifications

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I will need the following certification(s):*

National State Chamber of Physicians (Please enter your CME No. in Personal data above!)

Medical certification for Austria or Switzerland

I do not need any certification or only a general certificate of attendance.

Address

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Company

Department

Addition to address

Street*

ZIP*

City*

Country*

Additional e-mail address for sending invoices

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Please also use the following e-mail address for sending invoices:

Communication

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Phone Number

Fax

Email*

Email (Verification)*

Membership

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Membership:*

DZIF

PEG

No membership

Fellow of the DZIF Academy:*

Yes

Profession

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Please select your profession:*

Please specify your information:

Scientist:

Clinician:

Other:

Affiliation

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DZIF affiliation:*

Other:

Self-disclosure on the Advertising of Medicines Act

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According to the Advertising of Medicines Act. "Heilmittelwerbegesetz" (§10), prescription-only medicines may only be advertised to “doctors, dentists, veterinary surgeons, pharmacists and persons who are permitted to trade in these medicines”.

Self-disclosure on the Advertising of Medicines Act*

I belong to this group of professionals.

I do not belong to this group of professionals.

Please fill in the following details in case you need an invitation letter

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Place of birth

Date of birth

Nationality

Passport - Date of Issue

Passport No.

Passport - Date of Expiry

Please note: invitation letters can only be sent after your payment has been received.

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At the Joint Meeting, photographs and video recordings will be taken, on which individual participants may be identified. Further information on data processing by the organizers can be found in the privacy policy.*

I have read and accept the privacy policy

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