Registration as (required field)
– Bitte auswählen –Club memberGuestSpeakerExhibitor

Registration for (required field)
– Bitte auswählen –General MeetingInformation DayBoth
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Data of the main applicant

Name/First name of the main applicant (required field)

Street + House number

Zip Code Residential Address

Telephone (required field)

Email (required field)

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Details about the rooms

Number of single rooms:
0123456

Number of double rooms:
0123456

Number of people (1–6, required field)
123456

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Person 1 (Mandatory – Main Applicant)

Last name/First name (required field)

Age in children

Club member?
YesNo

Childcare is needed for this person?
YesNo

Does this person require liquid oxygen?
YesNo

If oxygen is required: HiFlow?
Yes

Seminar selection (required field)
– Bitte auswählen –Seminar 1: Children & Young People with Alpha-1Seminar 2: Meeting Point for RelativesSeminar 3: Alpha-1 & the Psyche

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Person 2 (optional)

Name first Name

Age in children

Club member?
Not specifiedYesNo

Childcare?
Not specifiedYesNo

Liquid oxygen?
Not specifiedYesNo

If oxygen is required: HiFlow?
Yes

Seminar selection
– Bitte auswählen –Seminar 1: Children & Young People with Alpha-1Seminar 2: Meeting Point for RelativesSeminar 3: Alpha-1 & the Psyche

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Person 3 (optional)

Name first Name

Age in children

Club member?
Not specifiedYesNo

Childcare?
Not specifiedYesNo

Liquid oxygen?
Not specifiedYesNo

If oxygen is required: HiFlow?
Yes

Seminar selection
– Bitte auswählen –Seminar 1: Children & Young People with Alpha-1Seminar 2: Meeting Point for RelativesSeminar 3: Alpha-1 & the Psyche

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Person 4 (optional)

Name first Name

Age in children

Club member?
Not specifiedYesNo

Childcare?
Not specifiedYesNo

Liquid oxygen?
Not specifiedYesNo

If oxygen is required: HiFlow?
Yes

Seminar selection
– Bitte auswählen –Seminar 1: Children & Young People with Alpha-1Seminar 2: Meeting Point for RelativesSeminar 3: Alpha-1 & the Psyche

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Person 5 (optional)

Name first Name

Age in children

Club member?
Not specifiedYesNo

Childcare?
Not specifiedYesNo

Liquid oxygen?
Not specifiedYesNo

If oxygen is required: HiFlow?
Yes

Seminar selection
– Bitte auswählen –Seminar 1: Children & Young People with Alpha-1Seminar 2: Meeting Point for RelativesSeminar 3: Alpha-1 & the Psyche

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Person 6 (optional)

Name first Name

Age in children

Club member?
Not specifiedYesNo

Childcare?
Not specifiedYesNo

Liquid oxygen?
Not specifiedYesNo

If oxygen is required: HiFlow?
Yes

Seminar selection
– Bitte auswählen –Seminar 1: Children & Young People with Alpha-1Seminar 2: Meeting Point for RelativesSeminar 3: Alpha-1 & the Psyche

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Allergies / Intolerances (optional)

I have read and understood the terms and conditions of participation in the "General Information" and I undertake to pay the costs arising from my registration.