Survey PLEASE COMPLETE THE SURVEY PERSONAL INFORMATION: First name * Last name * Title Organisation * Address * Postal/Zip code * City * Country *United KingdomUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArmeniaArubaAustraliaAustriaAzerbaijanAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaireBosnia and HerzegovinaBotswanaBouvet Island (Bouvetoya)BrazilBritish Indian Ocean Territory (Chagos Archipelago)British Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCuraçaoCyprusCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKazakhstanKenyaKiribatiKoreaKoreaKuwaitKyrgyz RepublicLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsMexicoNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Netherlands)Slovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & S. Sandwich IslandsSpainSri LankaSudanSurinameSvalbard & Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsU.S. Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe E-mail * Confirm E-mail * Phone number * HOTEL ACCOMMODATION: The accommodation is organised at Hotel Westin with special congress prices. Alternatively, we also offer accommodation near Westin hotel, Hotel Garden (approximately 3 minutes walk) and Hotel Dubrovnik (approximately 10 minutes walk). I don't need accommodationHotel Westin - Single room 98 EURHotel Westin - Double room 110 EURHotel Dubrovnik - Single room 120 EURHotel Dubrovnik - Double room 140 EUR * Prices are expressed per room per day, breakfast is included in room price. FLIGHT DETAILS: Please enter the planned flight details: TRANSFER SERVICE: Do you need a transfer service from and to the airport?NoYes DIETARY REQUIREMENTS: Nothing specialVegetarianVeganDairy-freeGluten-freeFood AllergiesReligious RestrictionsOther Explain dietary requirements: MEETINGS: Participation to the *:ESPRM General Assembly, Thurdsay 30th March 2023UEMS PRM Section and Board Meetings and General Assembly, Friday 31st March 2023 and Saturday 1st April, 2023Assembly of the European College of PRM (ECPRM)Both meetings You are *:Delegate of SectionDelegate of BoardDelegate Section and BoardESPRM AmbassadorOther SOCIAL EVENTS: Participation to the:Guided Walk Tour, Thursday 18:15-19:15 or Saturday afternoon 3:00-4:00 pmDinner in a restaurant on Thurdsay 30th March 2023, app. 7.30 pm (10 minutes walk)Gala dinner on Friday 31st March 2023 , app. 8:00 pm (5 minutes walk) ACCOMPANYING PERSON: Will there be an accompanying-person?NoYes DONE: