* Granting consent and providing specified information is necessary for participation in the CAEM 2019 conference organized by the University of Warmia and Mazury in Olsztyn. * I agree to the processing of my personal data in accordance with the law on the protection of personal data in connection with the implementation of the application. Regulations Name * First name * I am a member of PTMR Occupational group * DoctorParamedicNurseMale nurseStudentAnother Institution / university (affiliation) * I want to take part in the gala dinner on 10/05/2019 (Friday) - dinner cost PLN 61.50 / person Proszę o wystawienie faktury VAT Address Street and house number * City * ZIP code * Telephone * Fax E-mail adress * Accompanying Person (Enter the name and surname of the person or leave the field blank if no such person is available) Invoice details (if different than above) NIP Name / Name and surname Street and house number City ZIP code