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First name *

Last name *

Place of residence *

E-mail *

Phone number *

Profession *

PWZ Number *

Czy pracujesz w placówce ochrony zdrowia lub salonie optycznym? *

Employed

Unemployed

Czy pracujesz w Placówce Ochrony Zdrowia lub Salonie Optycznym?

Brak etykiety

Employer Information

Johnson&Johnson, as a member of MedTech Europe, adheres to the principle of transparency in its cooberation with HCPs. In accordance with the MedTech Europe Code of Ethics, Johnson&Johnson is obliged to notify your employer or supervisor of your participation in the Symposium, therefore the indication of employer data is mandatory.

Email address *

Workplace name

Workplace address

City

Postal code

Would you like to apply to the Organiser for free accommodation on 30-31 May 2025? *

yes, I wish to apply for free accommodation and confirm that I do not reside in the city where the Symposium is organised

no

Would you like to be accommodated in a double room with another registered Symposium Participant? *

Yes

No

Please provide the details of the registered Symposium Participant with whom you would like to be accommodated.

First name *

Last name *

Email address *

Informacje dotyczące uczelni

Uczelnia:

Kierunek:

Miasto:

Kod pocztowy:

Employer Information

Employer email *

Workplace name:

Street no.:

City:

Postcode:

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Password * Password must contain at least 10 characters, including one uppercase letter, one number and one special character (!^&*()\-_+.)

Confirm password *

* I hereby declare that I have read and accept the Rules and Regulations of the 14th EYE HEALTH ADVISOR® International Scientific Symposium.

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* I agree to the processing of my personal data in accordance with Privacy Statement

By registering, you accept the processing of your personal data related to your registration, participation, management of your Symposium participant account, as well as the organisation of the Symposium. In addition, we may process your personal data when you use interactive features provided voluntarily during the Symposium, such as surveys, research, Q&A sessions and others. Please be aware that your personal data may be transferred to countries outside of your country of residence, including the United States, which may apply different data protection rules than those applicable in your country. The processing of your personal data will be carried out in accordance with our Privacy Policy.

The 14th EYE HEALTH ADVISOR® International Scientific Symposium is a scientific event funded by Johnson & Johnson Poland Sp. z o.o. Please choose and tick the appropriate statement for you: *

I have no conflict of interest

I have a conflict of interest

Register for the Symposium

Czy pracujesz w Placówce Ochrony Zdrowia lub Salonie Optycznym?

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