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Registration form - EFPC conference 2019: Primary Care and local communities: Health equity for everyone, everywhere.

Please fill out a separate registration for each member of your Institute who will be attending the conference. Use the name of the institute which is known by the EFPC secretariat. (If you do not know this name, please check the EFPC website).

Please fill in the form

Yes No

Yes, I will attend the pre-conference site-visits program on
Sunday afternoon 29 September( + € 100)
Yes, I will attend the pre-conference Harvard Seminar program on
Sunday afternoon 29 September( + € 100)
No, I will not attend the pre-conference

Students
(€ 175)
Non members
(€ 425)
EFPC members
(€ 250)

Would you like to become an EFPC member for the upcoming year until next year conference and have the membership fee included in the conference fee?
Yes, individual membership ( + € 150 euro)
Would you like to become an EFPC member for the upcoming year until next year conference and have the membership fee included in the conference fee?
Yes, individual membership ( Total will be: € 150 euro + € 250 euro)
Yes, institutional membership (Total will be: € 385 euro + € 250 euro)
No, do not include the membership fee

Individual


Small Institute


Medium Institute


Large Institute


Premium Institute

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