Tr@inforPedHIV 2017 Registration

Please fill in your details below * indicates a required field.

Personal information
  First name*    Error: required field  
  Last name*    Error: required field  
  Year of birth
(minimum age 18)
 
  Nationality*    Error: required field  
  Gender*   Male | Female  Error: required field  
  Work/Institution address* (please enter full postal address)

   Error: required field  
  Work/Institution country*    Error: required field  
  Home address* (please enter full postal address)

   Error: required field  
  Home country*    Error: required field  
  Contact telephone number* (please include country code, e.g. +44 for UK)    Error: required field  
  Contact fax number (please include country code, e.g. +44 for UK)  
  Contact email address*    Error: required field  
  Re-enter email address*    Error: email address does not match  
 
Professional profile
  Profession*    Error: required field  
  If other, please specify    Error: required field if selected other above  
  Have you completed your professional/postgraduate training?*   Completed | Underway  Error: required field  
 
Experience with HIV infection
  Are you currently looking after children with HIV infection?*
  Yes | No  Error: required field  
  If yes, how many?    Error: required field if selected yes above  
 
Membership
  ESPID*   Yes | No  Error: required field  
  CHIVA*   Yes | No  Error: required field  
 
Have you participated in a previous Tr@inforPedHIV course?
  2005 course*   Yes | No  Error: required field  
  2006 course*   Yes | No  Error: required field  
  2007 course*   Yes | No  Error: required field  
  2008 course*   Yes | No  Error: required field  
  2009 course*   Yes | No  Error: required field  
  2010 course*   Yes | No  Error: required field  
  2011 course*   Yes | No  Error: required field  
  2012 course*   Yes | No  Error: required field  
  2013 course*   Yes | No  Error: required field  
  2014 course*   Yes | No  Error: required field  
  2015 course*   Yes | No  Error: required field  
  2016 course*   Yes | No  Error: required field  
  Type of participation in previous Tr@inforPedHIV course(s)   Online | Residential | Both
 
Level of English*  Error: required field  
  Advanced
  Intermediate
  Elementary
 
Further requirements
Do you have any specific dietary requirements (e.g. vegetarian)?
 
Do you have any other requirements (e.g. wheel chair access)?
 
 
Registration*  Error: required field  
 

Registration for the Online only course (without residential) is now closed.

Early bird fees are available for payment received on or before 5 May 2017. Please note that the early bird rates apply only to payments received (not just online registration forms submitted) by this date.

GroupTypeFeeEarly bird fee
Participants from resource-limited settings*Online + residential*** (€150)-
ESIPD/CHIVA members**Online + residential*** (€750) (€700)
Other participantsOnline + residential*** (€1000) (€950)

* Resource-limited settings are considered, for this purpose, to be countries included in the low-income, lower-middle-income and upper-middle-income economies list of the World Bank economy classification. Applicants from these countries must provide proof of their residence (e.g. a copy of their passport, or headed letter from their place of work) in order to be eligible for this fee.

** If you are an ESPID/CHIVA member please send a copy of your badge or membership acknowledgement.

***The Online + residential fee excludes travel and accommodation costs. Participants attending the conference will need to budget separately for these, and any other travel-related expenses.

 
Payment*  Error: required field  
 

We recommend that you print or save a copy of our Fees and booking conditions, for future reference.

Preferred payment method:

  Credit card (via PayPal only)
  Bank transfer (all charges to be paid by applicant)
 
 
Bank transfers should be made to the following account:
 
Account Holder:Fondazione Penta Onlus
Name of Bank:Banco Popolare Società Cooperativa
Account Number:0000 0000 1813
BIC/swift code:BAPPIT21723
IBAN:IT11 U 05034 62690 0000 0000 1813
 

PLEASE NOTE: Submission of your online registration form does not guarantee that your registration has been accepted. Your registration will only be confirmed when full payment has been received and a receipt of your payment has been sent.

You will receive full details for making your payment once you have submitted the online registration form.

 
Receipt of payment to be issued to:*  Error: required field  

A full valid postal address is required. Your registration will not be confirmed if this field is not completed.

  Work/Institution address provided above
   
  First name  
  Last name  
  Email  
  Institution  
  Address  

(please enter full postal address)

  Country