SBP Workshop - Madrid - October 2019“From Push to Pull: how to create a culture of continuous learnng in Santander”17-18 OctoberStep 1 of 425%Personal information:Title*DrMrMrsMsProfName* First Last Job Title*Email* Company/Institution*Address* Street Address Address Line 2 City ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Phone (Intl.)Mobile Phone (Intl.)ID/Passport number*Purchase OrderAffiliated to VAT ?*YesNoVAT number*My portraitPlease attach your photo in JPG format (full face portrait; 1MB max.). The photo will be printed in the event booklet to facilitate networking.Accepted file types: jpg.Catering:I will join the dinner on 17 October*YesNoI am allergic toalmondsblueberriesboletus mushroomchivesfigshazelnutsshellfishotherif 'other', please specify:*dietary requirementsno dairy productsno fishno glutenno meatno nutsno porkno shellfishveganvegetarianotherif 'other' please specify:* Membership:Membership Status*EFMD Company memberEFMD invited guestNon-memberAs EFMD Company Member or Invited Guest you can attend FOR FREE (hotel accommodation excluded)Invited guest = ONE free seat to attend ONE workshop for discovery for non-membersRegistration Fee:As Non-member Price: 700,00 € VAT (21%) 0,00 € Cancellation Policy:Cancellations must be confirmed in writing. If we receive notice of your withdrawal before 10 October 2019, a cancellation administrative fee of 75€ (+VAT) will be charged. After this date, we regret we are unable to refund any fees. However, in such cases substitutes are welcome as long as EFMD receives notification of the name, title and address of the substitute.Option:Do you want to register a second person from the same institution ?*(the second registration comes with a 10% reduction on the fee)NoYes Personal information second participant:Title*DrMrMrsMsProfName* First Last Job Title*Email* Phone (Intl.)Mobile Phone (Intl.)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.Fee for the second Non-member Price: 630,00 € Catering second participant:I will join the dinner on 17 October*YesNoI am allergic toalmondsblueberriesboletus mushroomchivesfigshazelnutsshellfishotherif 'other', please specify:*Dietary requirementsno dairy productsno fishno glutenno meatno nutsno porkno shellfishveganvegetarianotherif 'other' please specify:* Total price:TOTAL 0,00 € The fee cover attendance to the meeting, documentation, meals and refreshments, but NOT hotel accommodations.Payment method*Bank TransferCredit CardPlease wait for our financial department to issue an invoice.Credit CardAmerican ExpressDiscoverMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Security Code Cardholder Name Your credit card information is passed directly from your browser to Stripe over a secure connection.General:I agree with the terms and general conditions stated on the EFMD website* YesI declare that all the information stated above is accurate, including allergies and dietary requirements.* YesI authorise EFMD to use all information communicated within the legal framework of its activities.* YesI 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.*You can unsubscribe or update your preferences at any time.YesNoTechnical information:Registration date Date Format: DD slash MM slash YYYY Organiser email Event referenceNameThis field is for validation purposes and should be left unchanged. 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