A3P Congress Water Bottle SponsorshipReservation form ✻ManagerContact* First Last Function*E-mail* Mobile*Billing informationCompany*Address* Street Address City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Intracommunity VAT numberAdditional information about your billing department, please specify the email and phone number of the person in charge of billing:Communication informationCompany name to display*Tarif*€3 900 (+VAT 20%) - I wish to sponsor the water bottles of the A3P International Congress in BiarritzTarif*€3 900 - I wish to sponsor the water bottles for the A3P International Congress in BiarritzAdditional information (optional)Payment InformationPayment method*Credit cardBank transferDo you need a quote (to establish a purchase order)?YesNoPurchase order numberTotal to be paid 0,00 € A3P Communications and Terms and ConditionsConditions of cancellation*The validation of this form attests to your commitment to pay the associated cost. In case of cancellation formulated in writing, 50% of the sponsoring amount will be retained, and you will not be able to benefit from a free participant. The totality one month before the beginning of the Biarritz Congress on October 11th 2022.A3P Newsletters subscriptions* Newsletter générale A3P Newsletter formations A3P Newsletter pharmasbiotech.comGeneral conditions of the A3P forms*The information collected on this form is recorded in a computerized file by A3P. This information is intended for the management of the A3P database, for invoicing, as well as for the marketing and sales department. These data will not be disclosed to third parties. In accordance with the law "informatique et libertés", the "Règlement Général sur la Protection des Données" (RGPD) as well as our Privacy Policy (https://a3p.org/a3p-privacy-policy/), you can exercise your right of access, rectification and deletion of these data. By submitting this form you acknowledge that you have accepted these terms and our Privacy Policy.NameThis field is for validation purposes and should be left unchanged.