EQUIS & EPAS Accreditation Seminar – Prague, 19-21 November 2018 EQUIS/EPAS Accredition Seminars - Prague - November 2018 19-21 November 2018 Step 1:Please select*EQUISEPASEQUIS & EPASPersonal information:Name* DrMrMrsMsProf Title First Last Job Title*Company/Institution*Address* Street Address City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Phone (Int'l)*Purchase OrderAffiliated to VAT ?*YesNoVAT number*My portraitPlease attach your photo in JPG format (full face portrait; 1MB max.). The photo will be added to the participants' list to facilitate networking.Accepted file types: jpg.Membership:Membership Status*EFMD Full MemberEFMD Affiliated MemberNon-memberPrice for the EQUIS module:as EFMD Full Member Price: 750,00 € as EFMD Affiliated Member Price: 850,00 € as Non-member Price: 950,00 € Price for the EPAS module:as EFMD Full Member Price: 750,00 € as EFMD Affiliated Member Price: 850,00 € as Non-member Price: 950,00 € Price for both modules:as EFMD Full Member Price: 1.125,00 € as EFMD Affiliated Member Price: 1.275,00 € as Non-member Price: 1.425,00 € Total price:Tax (21% CZ VAT) 0,00 € TOTAL 0,00 € These fees cover attendance to the meeting, documentation, meals and refreshments, but NOT hotel accommodation. Payment method*Please note that we cannot accept Debit Cards Bank TransferCredit CardCatering:I will join the EQUIS dinner on Monday 19 November 2018*YesNoI will join the EPAS dinner on Tuesday 20 November 2018*YesNoI am allergic toalmondsblueberriesboletus mushroomchivesfigshazelnutsshellfishotherif 'other', please specify:*Dietary requirementsno dairy productsno fishno glutenno meatno nutsno porkno shellfishveganvegetarianotherif 'other', please specify:*General:I agree with the terms and general conditions stated on your website.* Yes I declare that all the information stated above is accurate, including allergies and dietary requirements.* Yes I authorise EFMD to use all information communicated within the legal framework of its activities.* Yes I agree for my name, picture and professional details to be added to the lists distributed to participants at this event.*Your contact details will never be disclosed to external parties nor used for commercial purposes.YesNoI agree to receive an e-mail newsletter and other communication material from EFMD.* I can unsubscribe or update my preferences at any time.YesNoTechnical informationRegistration date Registration IDEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.