Registration Form - Allergy School on Eosinophilic Esophagitis

16 - 18 March 2017, Rotterdam - Vlaardingen, Netherlands


If you are an EAACI member please enter your Member Login and Password and press 'Confirm'. All your membership information will appear below.

Member Login (EAACI Number)*
EAACI Membership Password*

 



*Forgotten your Login or Password? Click here to retrieve your login data from the Members Area.

Have you paid your EAACI membership fee for this year yet? If not, please login to the Members Area at www.eaaci.org (My Membership -> Finance).
Please note that if you are an EAACI Member, your membership must be fully paid up in order to benefit from the reduced registration fee.

Not an EAACI member yet? Click here to apply.

If you are not an EAACI member please write your personal information requested below.


Personal Data

Please use Title Case when filling in the form (i.e. Smith).
Please use English Alphabet only (do not use special international characters).

Family Name
First Name
Year of birth (yyyy)
Address
Postal code
City or State
Phone Number (include Country Code)
Mobile Phone Number (include Country Code)
E-Mail
Re-confirm E-Mail
Fax Number (include Country Code)


*If you are an EAACI member and you change any personal data above (e.g. your address), please note that this will be updated automatically into your EAACI membership profile.


Professional Details

Your answers to the following questions will help us in preparing scientific programmes for future events.


Letter of Invitation

Please click below if you require a letter of invitation for visa purposes.

Please note that the Letter of Invitation will be sent to you after EAACI has received your full payment for the meeting registration. EAACI may ask you to provide some additional documents (Copy of passport, contact details of the institution you work for, etc.) before issuing the Letter of Invitation.


Accommodation

I would like to share the room with
(if you have no preference, room allocation will be done by EAACI Headquarters)

The registration package includes accommodation in a shared twin room (2 nights, from 16-18 March 2017) and meals during the Allergy School. For any additional nights (arriving before 16 March and departing after 18 March 2017), please contact the Delta Hotel directly at +31 10-4345477, info@deltahotel.nl. For any other questions regarding your accommodation, please contact EAACI Headquarters.


Dietary Requirements

Please indicate below if you have any special Dietary Requirements (Vegetarian, etc.).
Dietary Requirements

Registration Fees

Please choose your registration category (if you are an EAACI Member you will be able to choose your registration category after entering your Member Number and Password at the beginning of this registration).


Payment of Registration Fee
Please note that if you are an EAACI Member, your membership must be fully paid up in order to benefit from the reduced registration fee.
If you have not paid your EAACI membership fee for this year yet, please login to the Members Area at www.eaaci.org (My Membership -> Finance).

To pay your Registration Fee you can choose either Credit Card payment or Bank Transfer.
  • Bank Transfer: you will receive our bank details by e-mail. Please note that all bank fees need to be settled by the payee.
  • Credit Card: it is possible to pay by Visa or Mastercard. You may be asked by the issuer of your card to enter a password to verify that the transaction is authorised by the card owner before completion of the payment process (3-D Secure technology).
Terms & Conditions - Click Here.

Total Ammount (EUR):


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