Registration

REGISTRATION FOR 64th CONGRESS OF THE U.I.C.H. 2017 IN BERLIN IS CLOSED

Personal Information

Title *

First Name *

Middle Name

Last Name *

Nationality *

Date of Birth (dd/mm/yyyy) *

Food Allergies or religious food restrictions

Name of hotel

Les Clefs d'Or Member Information

This is an official registration document of 64th UICH-Les Clefs d’Or Congress and cannot be used for any other purpose by an individual or association as the information is confidential and may be legally privileged, It is intended solely for registration purpose of Les Clefs d’Or members and any false declaration or willful omission of details will make this registration illegible, the applicant is bound by the rules and regulations of Les Clefs d’Or and to adhere to the society’s code of ethics.

Member Chapter *

Position at Les Clefs d'Or *

Member Since?

Are you attending international congress for the first time?

International Les Clefs d'Or Member No.

T-Shirt Size *

Congress Information

Congress Hospitality Desk Opens at 08:00hrs on March 23rd, 2017, Hotel Check In time is at 03:00pm

Early Check IN'S and Late Check OUTS are subjected to availability.

Congress hotel is covered for 5 nights from March 23rd, 2017 for Arrival and March 28th, 2017 for Departure.

Room Type *

Total

Name of sharer *

Is the sharer a Les Clefs d'Or Member?

T-Shirt Size *

Position at Les Clefs d'Or *

Would you like to split the total amount?

Yes No

Spouse Program Selection on Day 4 during General Assembly *

Leisure Day Selection on Day 5 *

Payment

Invoice Address

Company

Recipient *

Address

City

State

Postal Code

Country

VAT No.

Transport Information

Type of Arrival *

a specific form to get your arrival details will be send to you via email in end of 2016

Email *

Confirm Email *

* required fields

You will receive an automatically response to your registration after completing this form to proceed with payment.