Older Registration

Mr.Ms.Dr.Prof.

Family Name

First Name

Mobile Phone Number

Address

Zip Code

City

State

Country

Registration Type

Masterclass
Not AnyMasterclass 1 Frontal Sinus DissectionMasterclass 2 Rhinoplasty Demo or DissectionMasterclass Both

Masterclass – ERS Junior Members
Not AnyMasterclass 1 Junior Frontal Sinus DissectionMasterclass 2 Junior Rhinoplasty Demo or DissectionMasterclass Both ERS Junior Members

Proof of date of birth

All Junior registrants must submit proof of their date of birth. The file must be an image or pdf file no bigger than 2mb in size.

Proof of country of residence

All Low/Lower – Middle Income Country registrants must submit proof of their country of residence by way of letter from their Department or Institution.The file must be an image or pdf file no bigger than 2mb in size.

Masterclass – ERS Junior Members
Not AnyMasterclass 1 Junior Frontal Sinus DissectionMasterclass 2 Junior Rhinoplasty Demo or DissectionMasterclass Both ERS Junior Members

Proof of date of birth

All Junior registrants must submit proof of their date of birth. The file must be an image or pdf file no bigger than 2mb in size.

Proof of country of residence

Dinner
NoYes

Number of Persons

Special/Accessibility needs

Payment Method
Credit CardBank Transaction
Payment can be made with all VISA, MASTERCARD and American Express Credit/Debit Cards

I hereby consent to the processing of the personal data that I have provided according to the GDPR data protection regulations.

Yes