Arbeitsgemeinschaft christlicher Ärzte

Already now we look forward to your visit
We ask you kindly to use the following form to register. For administrative reasons we need a separate registration for EVERYBODY who attends the conference.
Asterisk (*) = required field (system insists on entry)

Gender*
Title*
First Name*
Surname*
E-Mail*
Confirm E-Mail*
Address*
ZIP / Post-code*
City / Town*
Country
Tel. / Mobile 1*
Tel. / Mobile 2
Fax
Date of birth (Day, Month, Year)
Work-status*
Seminar I*
Seminar II*
Vegetarian
Desired room
Childcare needed
Others may view my data for organization-purposes and / or to organize driving-communities	I agree I do NOT agree
Notes (e.g. preferred room-mates,...)

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MEDKong'11 — Registration