Safety days 2019

1

Lastname

2

Firstname

3

Company

4

Function

5

Address

6

Zip code

7

City

8

Country

Choose one of the following answers

9

Email

Format: xxx@yyy.zz

Please check the format of your answer.

10

Phone number

11

Registration

Choose one of the following answers

12

Student

Yes No

13

I take part in the buffet dinner on Wednesday 18.09.19 at 7 p.m. at ROSAS Center Fribourg (Passage du Cardinal 13B, Halle bleue, CH-1700 Fribourg)

Yes No

14

Special diet

15

How did you hear about the ROSAS Safety Days?

Select all that apply

16

Payment

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