Personal Data First Name* Last Name* Title Communication Phone* Email* Correspondence email address Professional Address Organisation* Department Street, Post Office Box* ZIP* City* Country* Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic of the Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong, China Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kosovo Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands North Macedonia Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin, French part Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten, Dutch part Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor l'Este Togo Tokelau Tonga Trinidad and Tobago Tunisia Türkiye Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Nations Interim Administration Mission in Kosovo United Nations Interim Administration Mission in Kosovo United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Different invoice address Field Please indicate your professional activity* Please indicate your area of expertise* Letter of invitation Please note that the invitation letter does not financially obligate the Conference organizers in any way. The invitation letter does not guarantee an entry visa to France. Please indicate below if you would like to receive an invitation letter to support your visa application. I require a letter of invitation* Yes No CSR For this edition of the 16th World Conference “Esophagus 2024”, the organizing committee would like to measure the carbon footprint of participants' travel to the conference venue. Please indicate your city of departure* Please indicate your mode of transport to get to the conference* Airplane Train Car Carpooling Public transportation Bicycle (Travel smart by choosing low-carbon modes of travel: find out how much CO2 you emit during your trip depending on the mode of travel you choose: monimpacttransport.fr) How many nights will you be staying in a hotel during the conference?* 0 1 2 3 more than 3 Accessibilty In order to welcome you in the best conditions, please let us know if you need special assistance during the conference Dietary needs The organizers will collaborate with catering suppliers to offer not only meat or fish options, but also sophisticated plant based, seasonal, and locally sourced menus to delegates. Locally sourced food not only reduces the carbon emissions but also supports local economies as well as local biodiversity. Vegan and vegetarian food is known to require less resources for its production, as well as being better for your health. Please choose* No restriction Vegetarian Vegan Gluten free Other Please indicate if you intend to join the following: Cocktail reception on 23 April* Yes No Lunch on 24 April* Yes No Lunch on 25 April* Yes No Lunch on 26 April* Yes No