From which Menicon office are you registering? City/country *

Your function title  *

First name according to passport *

Last name according to passport *

Nationality *

Passport number *

Date of issue *

Date of expiration *

Please upload your (valid) passport here.  *

To help us organize the event smoothly, please share your flight schedule (travel route, dates and timings). *

Overnight stays from March 17 - 19 are included. In case you would like to extend your stay at the hotel **, please let us know your preferred check-in and check-out dates. *

*Additional overnight stays are subject to availability

**Costs for additional overnight stays are at your own expense and will be invoiced by your Menicon office. 

Emergency contact 
Please provide the name and telephone number of your emergency contact *