Registration

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

For relaxed travel, we recommend our exclusive Event tickets in cooperation with the Deutsche Bahn. Further information can be found here https://www.headandneck-symposium.de/.

If you require hotel accommodation or more information about the conference, please refer to the congress website: https://www.headandneck-symposium.de/.

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

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Personal Data

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Participation category*

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)*

Self-disclosure on the Therapeutic Products Advertising 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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