First Name * Last Name * email * National Society * - Select -Algerian Society of Internal MedicineArgentinian Society of Internal MedicineAustrian Society of Internal MedicineBelgian Society of Internal MedicineCypriot Society of Internal MedicineCzech Society of Internal MedicineEuropean Federation of Internal MedicineEuropean Journal of Internal MedicineEuropean Journal of Case Reports in Internal MedicineEstonian Society of Internal MedicineFinnish Society of Internal MedicineFrench Society of Internal MedicineGerman Society of Internal MedicineIcelandic Society of Internal MedicineIsraeli Society of Internal MedicineItalian Society of Internal MedicineItalian Federation of Associations of Hospital InternistsHellenic Society of Internal MedicineLatvian Society of Internal MedicineLebanese Society of Internal MedicineLithuanian Society of Internal MedicineAssociation of Physicians of MaltaMoroccan Society of Internal MedicineMacedonian Association of Internal MedicineMexican College of Internal MedicineNetherlands Society of Internal MedicineNorwegian Society of Internal MedicinePolish Society of Internal MedicinePortuguese Society of Internal MedicineRomanian Society of Internal MedicineRussian Scientific Society of Internal MedicineSerbian Association of Internal MedicineSlovak Society of Internal MedicineSlovenian Society of Internal MedicineSpanish Society of Internal MedicineSwedish Society of Internal MedicineSwiss Society of General Internal MedicineTurkish Society of Internal Medicine Royal Colleges of Physicians UK Royal Colleges of Physicians of Edinburgh Country * - Select -AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R., ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Contact number 3227259424 Position in National Society * Will you attend the 8th EFIM Day in Brussels * - Select -YesNo Will you attend EFIM Dinner on 12th of October? * - Select -YesNo If you will be accompanied, please state the name of your guest Leave this field blank CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
