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Summer Academy Registration Form

* Required fields

European Association for Palliative Care

Address of the participant's institution
Title (Ms., Mrs., Mr.) ^*
Institution ^*
First Name ^*
Last Name ^*
Street Address ^*
City, State, Zip Code ^*
Email ^*
Phone Number ^*
Billing address (if different to address institution)
Institution
First Name
Last Name
Street Address
City, State, Zip Code
Registration details for Summer Academy
	I am registering for Summer Academy (23^rd – 24^th August 2021)
Accommodation and Meals
I need accommodation on the…
	…23^rd August
Meals
	The overnight stay of 23 August includes lunch and dinner on 23 August as well as breakfast and lunch on 24 August. If you need additional accommodation or meals or if you are not staying overnight, please indicate this in the box below. The hotel rooms are single rooms. If you would like a double room, please indicate this in the box below. If you cancel your participation after 6 August, we will still have to charge you the registration costs.
	Food preferences
	Vegetarian menu
	Meat menu
	Please indicate any special diets and/or allergies that need to be considered
Comments and wishes
	Please indicate additional comments or wishes below
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