Registration Form

Remarks:
*) Obligatory.
¹) Date of birth is required for certificate issuance.
²) Data for recognition of educational credits (applies only to Czech participans).
³) By filling in the Lecture title, you will apply for active participation.

Academic title(s)

First name *)

Last name *)

Institution - name

Institution - department

Institution - street address

Institution - city

Institution - ZIP

Institution - country

E-mail *)

Phone (international format) *)

Date of birth (YYYY-MM-DD) ¹)

Physician ID ²)

UNIFY membership ID ²)

Lecture title ³)

Participation *)

On-site

Remote (via Internet)

Dinner *)

Yes

No

Attendance

Friday (1st day)

Saturday (2nd day)

Spam protection (CAPTCHA) *)
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31^st Kubát's Days
Symposium with international participation | March 13-14, 2026, Prague, Czech Republic
www.pojivo.cz | www.ortoprotetika.cz