Individual Registration

Please enter your information in the form below. All fields marked (*) are required

Means of communication (е-mail) *

Surname *

Name *

I am registering and planning to participate in the event as a *

Speaker - I confirm

Participant - I confirm

I would like to take part in the Congress of the Association's members

Date of birth (day, month, year) *

Тelephone number (specify country code) *

Education (specify - higher education, professional pre-university) and academic degree *

Where are you from? *

Specify the region (oblast) and settlement (city, village, other) *

Place of employment *

Title of the position held *

Тitle (theme) of the report (for speakers)

I have sent the abstracts to asirukr@gmail.com (for speakers)

I want to receive announcements and invitations to other events *

yes

I have carefully checked all the data and confirm that everything is correct *

I confirm

By filling out and submitting the form, you consent to the collection and processing of personal data *

I confirm

You confirm your agreement with the Privacy Policy and the Public Offer Agreement set out on the website https://www.asir.com.ua *

yes

Amount

₴

Discount Amount

₴

Gross Amount

₴

Payment Method

Оплата карткою

Billing Zip Code*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*