Northern Lights 2022
Full Legal Name
Date of Birth
I will attend the event for the full 3 days
Name of Workplace
I will need a support letter provided by Kerecis to report my hospital/work administration
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?
I will be travelling alone
If no: Who will be joining you?
I will start my travel from
Name of airport
(Please write here if you have any allergies or special dietary wishes)
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 email@example.com