Message from Alliance4Life

To register for the event, please, fill in the following form.

1.	Name *
2.	Surname *
3.	Institution/Company *
4.	Country *
5.	E-mail *
6.	Do you agree to share your contact details (name, institution) with other participants? *

Items with red * are mandatory.

Please pay attention to the correctness of your e-mail address on which you will receive confirmation of your registration. Thank you.