2020 BSIS Symposium Nice, France4-5 May 2020 Date Date Format: MM slash DD slash YYYY Personal information:Name* Mr.Mrs.Ms.Dr.Prof. Title First Last Job Title*Company/Institution*Address* Street Address City ZIP / Postal Code Country*AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCabo VerdeCambodiaCameroonCanadaCentral African RepublicChadChileChinaColombiaComorosCongo (Congo-Brazzaville)Costa RicaCroatiaCubaCyprusCzechiaDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly SeeHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (formerly Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorth MacedoniaNorwayOmanPakistanPalauPalestine StatePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVenezuelaVietnamYemenZambiaZimbabweRegretfully, we are not able to process your registration. Please contact firstname.lastname@example.org for further information.Email* PhonePurchase OrderAffiliated to VAT ?*YesNoVAT number*My portraitPlease attach your photo in JPG format (full face portrait; 1MB max.). The photo will be added to the participants list to facilitate networking.Accepted file types: jpg.Fee and conditionsFee Price: 350,00 € Coupon Total 0,00 € Cancellations must be confirmed in writing. If EFMD GN receives notice of your withdrawal before 20 April 2020, a cancellation administrative fee of 50 € will be charged. Thereafter, we regret that we are unable to refund any fees. However, in such cases substitutes are welcome at no extra cost as long as EFMD GN receives notification of the name, title and address of the substitute.Payment method*Bank TransferCredit CardYour credit card information is passed directly from your browser to Stripe over a secure connection.Catering:Network dinner on 4 May:*yes, I will joinno, I'm unable to joinI am allergic toalmondsblueberriesboletus mushroomchivesfigshazelnutsshellfishotherif 'other', please specify:*Dietary requirementsno dairy productsno fishno glutenno meatno nutsno porkno shellfishveganvegetarianotherif 'other', please specify:*General:I agree with the terms and general conditions stated on your website.* Yes I declare that all the information stated above is accurate, including allergies and dietary requirements.* Yes I authorise EFMD & EFMD GN to use all information communicated within the legal framework of its activities.* Yes I agree for my name, picture and professional details to be added to the lists distributed to participants at this event.*Your contact details will never be disclosed to external parties nor used for commercial purposes.YesNoI agree to receive an e-mail newsletter and other communication material from EFMD & EFMD GN.*You can unsubscribe or update your preferences at any time.YesNoTechnical InformationCommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.