New account - individuals

Enter the "Username" and "Password" you choose. Remember them to be able to log in to the system in the future! Use only international letters and numbers for your "Username", we do not recommend using any spaces or diacritics.
The minimum number of characters for the "Password" is 6.

IF YOU WANT TO APPLY FOR ACTIVE PARTICIPATION, FILL IN YOUR WORK ADDRESS

Fields in bold are required

Username
Password	(6 characters at minimum)

Personal data

Sex

male female

Academic degree

Name

Second name

Surname

Scientific degree

Date of birth

day

month

year

Evidenční číslo lékaře (ČLK ID)

?
(ČLK ID najdete v registru lékařů na stránkách ČLK)

Address

Address type	work private
*Company / Hospital
*Department
Address
City	(Enter the name of the CITY without any numbers or city parts.)
Post code
Country

Contact

E-mail
	(Fill in the form carefully, we do not bear any responsibility for incorrect data and the following problems with post that cannot be delivered.) No e-mail? Create a new e-mail:seznam.cz, google.com
Telephone
Mobile phone
Fax

Your approval

Approval to personal data processing	YES I declare on my word of honour that the information I provided is true and complete. I further declare hereby that in the sense of Act no. 101/2000 of Coll., on personal data protection, and Act no. 480/2004 of Coll., on services of information companies, I am granting the employees of Česká kardiologická společnost (CSC), located in Brno, Pekařská 72, my approval to process my personal data in the range stated above for administration, processing and storing personal data. To be able to proceed in the CSC online system, or to be able to finish your registration, you have to AGREE.
Approval to obtaining promotion emails	YES I agree
	The email will be used to send out promotion information about symposia and other company information associated with CSC events. This approval can be withdrawn any time.

* fields marked like this only have to be filled in if you are entering your work address

ALL DETAILS PROVIDED BY YOU WILL BE CONSIDERED PERSONAL AND WILL NOT BE GIVEN TO ANY THIRD PARTY IN COMPLIANCE WITH VALID REGULATIONS.