Quality Assurance Academy + Supplementary Report Writing Workshop Budapest, Hungary11-14 December 2019 Date Date Format: MM slash DD slash YYYY Fields marked with * are mandatory.Personal information:Name* Title Mr.Mrs.Ms.Dr.Prof. 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* Phone*Purchase OrderMy portraitPlease attach your photo in JPG format (full face portrait; 5MB max.). The photo will be added to the participants list to facilitate networking.Accepted file types: jpg.My CV*Please attach your concise CV in PDF format.Accepted file types: pdf.My motivation*Please enter a short summary of your motivation as to why you want to attend the programme (in 1000 characters maximum).Membership:Membership Status*EFMD memberNon-memberFee:Quality Assurance Academy fee: Price: 2.400,00 € Option: Supplementary Report Writing Workshop?*YesNoReport Writing Workshop fee: Price: 1.000,00 € Quality Assurance Academy fee: Price: 2.700,00 € Option: Supplementary Report Writing Workshop?*YesNoReport Writing Workshop fee: Price: 1.200,00 € If you received a voucher code, please enter it here:voucher code Total 0,00 € Payment methodBank transferPlease wait for our financial department to issue an invoice.Social Events:I plan on attending the following social events:Social events Guided city tour (Wednesday, 11 December) Group Activity – TBC (Thursday, 12 December) Catering:I will join the networking dinner on 11th December*YesNoI will join the networking dinner on 12th December*YesNoI will join the networking dinner on 13th December*YesNoI 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 Information:EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.