Step 1 of 2 - Delegate Details 50% Delegate Name* Prefix Dr.Prof.Mr.Mrs.Ms. First Last Institution/Organisation*(Maximum 40 Characters)Job Title/Role*(Maximum 40 Characters)Department(Maximum 40 Characters)Telephone*(Include Country Code)Delegate Email* Enter Email Confirm Email How you plan to attend* I will be attending in-person I will be participating virtually I am not sure yet (we will contact you nearer the time) Dietary Requirements Vegan Vegetarian No Beef No Pork No Sea Food No Fish No Dairy Allergy/Dietary NeedsPlease inform us of any allergy or specific dietary needs. Please tick if you would like someone to contact you to discuss access needs or special assistance Please indicate which of the following best describes your Role* Academic/Researcher/Scientist Government Employee Health/Policy Campaigner Health Care/Medical Professional Commercial Politician Terms and Conditions* I agree with the T&C's Terms and Conditions can be viewed here Read our Ts & Cs Please Select A Ticket*Please note that the discounted rate is only applicable to individuals working directly for academic/charity/not-for-profit institutions. Early Bird - Academic/Not For Profit/Govt: $140.00 Early Bird - Private Business/Healthcare: $200.00 Early Bird - International Business/Commercial: $350.00 Discount Code/CouponIf you have been sent a discount code please use it here. Don't forget to press "Apply" This field is hidden when viewing the formHotel AccommodationWe have secured a limited number of room nights at the Georgetown Marriott Hotel. If you would like to confirm your accommodation with your booking please select which nights from the list below. If you are planning a longer stay, you can use the Hotel Booking link on the Accommodation page found on the Summit website. 2 Nights - 16 & 17 May: $518 +(14.95% Tax) 1 Night - Monday 16 May: $259 +(14.95% Tax) 1 Night - Tuesday 17 May: $259 +(14.95% Tax) Billing Total $0.00 How would you like to pay?* Pay by Invoice Pay by Credit Card Billing Address*Please use this space to provide the billing address for your invoice or registered credit card. 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We may also send you relevant marketing information about other E-Cigarette Summits, under the lawful basis of Legitimate Interest which you may subsequently opt out of (see our full privacy statement below). If you are an individual unattached to a business then we will only send you marketing information if you give us specific consent to. Please indicate whether you are representing a business or attending as an individual. Full details of our terms and conditions and privacy statement are here https://www.e-cigarette-summit.co.uk/terms-and-conditions/ Representing a Business Attending as an individual - interested in future related events Attending as an individual - not interested in future events CAPTCHA