How to register Always register online if possible via 2013.excellence-in-paediatrics.org. If this is not an option, you may register for the conference by sending the Registration Form with a scanned copy of your receipt/remittance slip showing all relevant payment information to the Conference Organisers. From 24th November 2013 onwards, registrations will be accepted only at the Conference Secretariat operating in the Conference Venue from 4th December till 7th December. Send your completed Registration Form to: The EiP 2013 Registration department Fax: +44 (0) 208 326 5726 Email: [email protected] Registration types and fees in 2013 Full Delegate Standard 24 Jun - 15 Sep Late 16 Sept– 24 Nov On-site 4 Dec - 7 Dec 690 Euros 750 Euros 830 Euros Trainee / Young investigator 350 Euros 490 Euros 580 Euros Participant from a developing country 350 Euros 490 Euros 580 Euros Nurse 200 Euros 250 Euros 300 Euros Student 100 Euros 150 Euros 200 Euros When you register, you will be charged the applicable fee on your registration date. Please note that the reduced registration fee will only apply for: • trainees / young investigators, i.e. doctors and researchers under 35 years of age. To be considered for this category, please attach a copy of your passport • participants from developing regions, as per the World Bank. To be considered for this category, please attach a letter of recommendation from your employer verifying your work place with full contact details. Developing regions, as per the World Bank website, please click on one of the following links, according to your location: EAST ASIA & PACIFIC (http://data.worldbank.org/region/EAP); EUROPE & CENTRAL ASIA (http://data.worldbank.org/region/ECA); LATIN AMERICA & CARRIBEAN (http://data.worldbank.org/region/LAC); MIDDLE EAST & NORTH AFRICA (http://data.worldbank.org/region/MNA); SOUTH ASIA (http://data.worldbank.org/region/SAS); SUB SAHARAN AFRICA (http://data.worldbank.org/region/SSA). • nurses will need to attach a proof of employment to their registration form to be considered for this category • students will need to attach a copy of their student ID card to be considered for this category Registration entitlements Participation in all scientific sessions Full delegate Trainee or young investigator Participant from a developing country Nurse Student p p p p p Entrance to the exhibition area p p p p p Participation in the opening ceremony p p p p p Conference materials p p p p p Coffee breaks p p p p p Lunch breaks p p p p p Certificate of attendance with CME credits p p p p p Payments. You can pay your registration fee by: 1. Making a bank transfer to the Conference Organiser using the details below. 2. Send your completed registration with a copy of your receipt/remittance slip attached Ordering Customer Name: Delegate Name: Account Name: IBAN: SWIFT/BIC: Conference Code: VAT No: (Enter payee name here) (If different to above) E I Congresses & Communications UK Ltd GB35MIDL40051570681894 MIDLGB22 EiP2013 GB 943 8010 33 Cancellations and substitutions policy. Please note that an administrative fee will be applied on any cancellation of a completed registration. In the unfortunate event of a cancellation, we will still help you reduce the damage through the policy shown here below. Please note that all refunds will be processed two (2) months after the conclusion of the Conference. The size of the administrative fee depends on how close to the event the cancellation is made. For written cancellations or alterations* received in 2013, the administrative fees are as follows: • • • • 30 Euros for written cancellations or alterations* received before 4 September 2013. 80 Euros for written cancellations or alterations* received from 5 September 2013 to 2 October 2013. 50% of the registration value for written cancellations or 80 Euros for alterations* received from 3 October 2013 to 1 November 2013. 100% of the registration value for written cancellations or 100 Euros for alterations* received after 2 November 2013. * In case of alteration, a completed Registration form must be submitted for the new (i.e. the substituting) delegate. Registration form Please use this registration form only if you cannot register online via http://2013.excellence-in-paediatrics.org • • • • This registration form is for 1 delegate only. All requested sections must be completed before you can register. Please use CAPITAL LETTERS only, and tick the boxes where appropriate. Submit your completed registration form to [email protected] or via fax to +44 (0) 208 326 5726, with attention to The Registrations Department, EiC2 Ltd. What type of delegate are you? Full Delegate Participant from developing country Trainee/Young Investigator Nurse Student What type of information took you to this registration form? Please select all applicable by clicking in the corresponding boxes Email from EiP, with a link + reminder to register I was invited by an industry representative My colleague or boss asked me to register Information received at a conference Advertised link in a medical publication One of the EiP 2013 speakers notified me Google or other search engine Social media (Facebook, Twitter, etc.) Publicly displayed poster advertisement Newsletter article or advertisement My medical association notified me I already visited Excellence in Paediatrics About you (please click once in the text box first, then type your name with the computer keyboard) 1. Last name 2. First name 3. You are a... Male Female 4. You are a... Doctor Professor Other Your contact details 5. Department 6. Organisation 7. Postal address 9. City 8. Post code 10. Country 11. Email 13. Fax 12. Mobile Travel Agency contact details (This section is to only be completed if you are a travel agency handling delegate registrations) 14. First Name 15.Last Name 17. Mobile 16. Email 18.Agency Name Your safety is important to us. Please indicate a contact person in case of emergency 19. Last name 20. First name 21. Email 21. Mobile Tell us about your work 22. What is your current work role ? Please select all applicable 23. In what type of setting do you work ? Please select all applicable Nurse or midwife Primary care (or any outpatient clinic) Paediatrician in training/junior doctor Secondary care (general hospital) General Practitioner/family doctor Tertiary care (children’s hospital) General Paediatrician Private practice Paediatric specialist Researcher and/or teacher Other (industry, social, government, etc.) Other University 24. How many years of post-graduate training or work experience do you have in paediatrics ? 25. Do you need an invitation for a visa for Qatar Yes No Check visa requirements for Qatar on the official website of The State of Qatar Ministry of Interior website: http://www.moi.gov.qa/site/english/channel/Visitors/index.html Billing Details Contact person for billing, and billing address 26. Last name 27. First name 28. Department 29. Organisation 30. Postal address 32. City 31. Post code 33. Country 35. Tel 34. Email 37. Do you need an invoice to make a payment? 36. Fax Yes No Important information. The Conference Organisers of the Excellence in Paediatrics reserve the right at any time to change the programme or to cancel or postpone the Conference. In the event of cancellation or postponement, their liability is limited to refunding any registration fee already paid. The Conference Organisers will notify registered participants at the address shown on their registration form of any decision to cancel or postpone. The Conference Organisers strongly recommend attendees take out their own insurance against any losses arising from cancellation or postponement of the Conference or the inability of a participant to attend for any reason whatsoever, and they accept no liability for any loss or damage suffered by any participant or accompanying person or other person whatsoever. It should be noted that the data given in this form will not be disclosed to any third parties who are not directly involved in the organisation of the Excellence in Paediatrics nor will it be publicised in any other way. Be a part of an International Paediatric Community - Become a Member You are invited to become a member of the Excellence in Paediatrics Community and use our unique online platform to: • • • • • • Upload your scientific profile Connect with colleagues from around the world Collaborate online and be a part of special interest groups to carry out collective tasks Access online paediatric resources and share your materials with the rest of the community Participate in clinical discussions through forums and blogs Stay updated with the latest paediatric news If you would like to become a member of the EIP Community, indicate your preference below and we will create your online profile and send your login details via email. No Yes 38. I want to be a member of the Excellence in Paediatrics Community I agree to the collection and processing of my personal data by EiC2, for the purpose of sending information materials (newsletters) in relation to conferences with similar topics, as well as promotional and advertising e-mails inaccordance with its advertising policy. I hereby confirm that I have read and understood the registration terms as well as the cancellation and substitution policy, which I accept without any reservations. 39. I do agree with the above statement about my personal data Yes No Date………………………………………………………… g Sn ia u ter………………………………………………………… An original signature is required; no typing.