44th ESNR Annual Meeting - Information required to attend onsite - PARTICIPANTS

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* 1. Please enter your personal details

Name *

Company

Permanent Address *

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Email Address *

Phone Number *

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* 2. Did you have Covid in the last 6 months

Yes

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* 3. Have you been vaccinated?

Yes, first dose

Yes, full cycle / two doses

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* 4. Which vaccine did you get?
*The following vaccines are approved by the Swiss Federal Office of Public Health. If you have been vaccinated with a vaccine not on this list, your proof of vaccination must also include the date of vaccination and the vaccine used.

Pfizer/BioNTech

Moderna

AstraZeneca

Janssen / Johnson & Johnson

Sinopharm / BIBP

Sinovac

Other (please specify)

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* 5. Please enter the date of your last vaccination dose

Date / Time

Date

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* 6. Please select one of the choices below - I will present at registration desk a valid certificate of:

completion of the full vaccination cycle with an EMA-approved vaccine at least from 14 days ago

recovery from COVID-19, with concomitant cessation of prescribed isolation following SARS-CoV-2 infection

performed a rapid antigenic or molecular test with a negative result for SARS-CoV-2 within 48 hours prior to entry into the country

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* 7. I give consent to ESNR to store the above information and pass on to the Swiss Federal Authorities if needed.

Yes

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* 8. I give consent to share my personal information (Name, Institution and email address) to industry sponsors

Yes

44th ESNR Annual Meeting - Information required to attend onsite - PARTICIPANTS

Question Title

* 1. Please enter your personal details

Question Title

* 2. Did you have Covid in the last 6 months

Question Title

* 3. Have you been vaccinated?

Question Title

* 4. Which vaccine did you get? *The following vaccines are approved by the Swiss Federal Office of Public Health. If you have been vaccinated with a vaccine not on this list, your proof of vaccination must also include the date of vaccination and the vaccine used.

Question Title

* 5. Please enter the date of your last vaccination dose

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* 6. Please select one of the choices below - I will present at registration desk a valid certificate of:

Question Title

* 7. I give consent to ESNR to store the above information and pass on to the Swiss Federal Authorities if needed.

Question Title

* 8. I give consent to share my personal information (Name, Institution and email address) to industry sponsors

* 4. Which vaccine did you get?
*The following vaccines are approved by the Swiss Federal Office of Public Health. If you have been vaccinated with a vaccine not on this list, your proof of vaccination must also include the date of vaccination and the vaccine used.