required fields
Title
i.e.: MD; MD PhD; Prof; Prof Dr.; Dr.;...
Last name
First name
Specialization
Cardiologist; pulmonologist; other;...
Focus on
i.e.:PAH, PH, IPF, ILD, Sarcoidosis,...
Institute name
Name of the hostpital / COE / University
Division name
i.e.: Division of pulmonary sciences & critical care medicine; Pediatric cardiology; Department of internal medicine;...
Business address
Full institute's address
Insititute internet site
Business phone
Mobile phone
Business e-mail address
Sponsor name
Name of the person who informed you about the Mondobiotech campus
Campus attendance date
Date of the campus attendance (from - to)
Preferences
Sharing room system?
Please answer with "YES" if you are willing to share the room with another attendee. The sleeping room are always separated only the bathroom is in common. In this case the sharing room system will be always with another person of the same gender. If you answer "NO" you will have a private room
none
yes
no
Name of the roomate?
Please indicate the name of the person with whom you want to share the room
Preferred travel method
by airplane, by train, by car,...
Preferred airline
Lufthansa, United Airlines, Continental, Swiss,...
Frequent flyer program name
Miles & More, Skywards, Skyteam, Oneworld,...
Frequent flyer number
Preferred departure city
name of the departure's city
Preferred seat
Window or isle
Preferred incoming date
Date of your departure to the campus
Preferred flying time
Morning, afternoon, evening
Preferred outgoing date
Date of your departure from the campus
Preferred flying time
Morning, afternoon, evening
Preferred arrival city
name of the arrival's city
Meal preferences (if available)
vegetarian, dietary, lactose intollerant,...
Allergies
Peanuts, Tree nuts, peppers, mushrooms, eggs,...
Preferred newpaper
The Times, Daily Telegraph, Frankfurter Allgemeine,...
Comments
