Zagreb International Medical Summit 10

PERSONAL INFORMATION

Name:
Surname:
Gender:	male female
Date of birth:
E-mail:
Mobile phone:
Address:
City:
ZIP code:
Country:
Did you participate in any former ZIMS?: Yes No
Foreign participants are obliged to enter passport number and passport expiration date!
Passport No: expires on:

INSTITUTION INFORMATION

University:
Faculty:
Department:
Are you a student or a doctor? Student since: currently enrolled in year of my study. Doctor since:
Are you an EMSA member?:	Yes No
Are you an IFMSA member?:	Yes No
If you are member of other student association, please specify:

ARRIVAL AND ACCOMMODATION INFORMATION

Check this box if you are from Zagreb.
Arriving on: from: with:
Departing on: to: with:
Do you need our assistance for arranging suitable accommodation? I need you to arrange an accommodation for me in a student hostel or a dorm! I will arrange it myself!

ABSTRACT INFORMATION

Are you an active participant (presenter)? Yes No

Please tell us more about your presentation.
Abstract topic
Presentation type	Oral presentation (with MS PowerPoint) Poster presentation
Title
Author(s)	Please separate values by comma.
Presenting author	(one of bellow typed authors)
Mentor(s)	Please separate values by comma.
Keywords	Please separate values by comma. Minimum of 4 keywords is needed.
You can either upload a document or write text directly.
Abstract document	Allowed file types: doc,pdf,rtf,docx,txt Maximum file size: 5MB
Abstract text	Minimum of 180 words is needed; maximum is 300. Current word count:

OTHER INFORMATION

Field trip:	I would like to go to field trip on the final day of ZIMS. maybe rather not
Diet type:	regular vegetarian other Please specify:
Special needs:
Any comments?

DISCLAIMER

The OC of 10th ZIMS and EMSA Zagreb can not be held responsible for accidents and loss of valuable personal properties. All damage brought to persons or things, is your own responsibility. Participants are strongly advised to take out their own personal and travel insurance coverage.

Included in the fee:
1.) Attendance to all lessons and workshops, promo and teaching material, ZIMS abstract book, ZIMS congress bag.

2.) Rich social (welcome party, several thematic parties) and cultural life (optional city sightseeing).

3.) Lunch and dinner on every congress day as well as welcoming dinner and gala dinner on final day. All coffee breaks.

In case you need an Invitation letter please inform us and we will send it to you (in PDF format) on your e-mail address, or as a hard-copy on your address right after we get the proof of your payment.

If you have any difficulties with registration; contact webmaster@zims.hr.
For all other information do not hesitate to contact info@zims.hr.

I agree with the terms and conditions.

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