Event		Midnight Sun 2022
	General Information
	Full Legal Name
	Professional Credentials
	Date of Birth
	Cell Phone
	I will attend the event for the full 3 days		Yes No
	Email Address
	Name of Workplace
	I will need a support letter provided by Kerecis to report my hospital/work administration		Yes No
	If yes: Please provide the address of the hospital and whom the letter should be addressed to
	What is the case you will be presenting at the event
	Will you need any assistance from Kerecis' Medical Writer to put the case together?		Yes No
	Kerecis Representative
	Travel Details
	I will be traveling alone		Yes No
	If no: Who will be joining you?
	I will start my travel from
	Name of airport
	Other (Please write here if you have any allergies or special dietary wishes)
	I accept the Terms and Conditions
	For all invited doctors and medical professionals; standard fare air travel, meals and lodging are covered by Kerecis for the duration of the workshop. While family members and/or spouses are not included, we can assist in making travel arrangements. We’ll do our best to accommodate their needs, and assist them in scheduling sightseeing and experiencing Iceland. If you’re having problem completing the form please contact events@kerecis.com