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Form

Information form for speakers

Your input will allow us to tailor the experience to your needs and ensure everything runs seamlessly.

Personal information

First name

Last name

Email address

Date of birth(DD/MM/YYYY)

Phone numberincluding country code

GenderMaleFemaleI prefer not to disclose my gender.

Nationality

Affiliationinstitution, department, position

Academic levelMScPhDMDMD/PhDProfessor

Other

Emergency contact

Name

Relationshipfamily, friend etc.

Phone numberincluding country code

Abstract details

Abstract title

Abstract authorsplease list them separated by commas

Abstractmax 250 words0 / 250

Photo for the book of abstractmin size 1080px x 1080px

No file chosen

Individual preferences

Food preferencescheck if applicableVegetarianVeganHalalAllergies

Allergiesplease list them

Accessibility/Special needs

Travel preferences

Do you need transport?YesNo

Transport details

Arrival date to Wrocław

Departure date from Wrocław

Transport details

Preferred mode of transport for arrival to WrocławPlaneTrainBus

Country and city of departure

Arrival date to Wrocław(arrival before the start of the school is allowed, however, the accomodation for the participant is covered from 20 – 25 October 2025)

Preferred departure date from Wrocław(check out from the accomodation is on Saturday, 25 October 2025)

Departure city(Wrocław preferably)

Preferred mode of transport for departure from the chosen cityPlaneTrainBus

Questions/Comments/Special requirements

Consent *

Yes, I agree with the privacy policy and terms and conditions.

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Infor­ma­tion form for speakers

Per­son­al information

Information form for speakers

Personal information