Application Form

For participation in the XXXVII Conference of the Association of Employers of Emergency Medical Services and

European Forum For Emergency Medical Services from

the 18^th to the 20^th May 2022.

Fields marked with an asterisk* are mandatory

Details of the employer

Name of employer*

Address of employer*

NIP*

Phone number*

E-mail address*

Details of the participant:

First name of the participant*

Surname of the participant*

Position*

E-mail address*

Phone number*

Date:

Place:

Given my participation in the XXXVII Conference of the Association of Employers of Emergency Medical Services and European Forum For Emergency Medical Services, hereinafter referred to as “the Event”, I agree to the processing of my personal data provided in the application form to the extent necessary for the organisation of the Event. Find out more about the processing of your personal data and your rights in the Privacy Policy *

Payment details

Bank Millennium S.A.

Bank transfer to the account no. 97 1160 2202 0000 0000 4260 9024

The transfer title should be the following: I Europejskie Forum Ratownictwa Medycznego

The deadline for submitting applications and payment is the 5th of May 2022.

The participation fee is 1950 PLN net per person.

Hosted by

Emergency Medical Services in Jelenia Góra

Address

ul. Cieplicka 126A
58-570 Jelenia Góra

Info

Contact Details

Created by TwojaReklama