ICCAI 2023 Speaker Registration This year’s conference takes place in-person at the University of Augsburg in Augsburg, Germany! Data Collection Information Document (PDF): English | German We are looking forward to seeing you! Email * First Name * Last Name * Affiliation (Institution or Company) * Institution/Company Address * What field do you work in? * Are you attending the banquet on Saturday? * YesNo Mobile Phone* Please include country code. Address* City* State/Province* Postal Code* Country* ArubaAfghanistanAngolaAnguillaÅland IslandsAlbaniaAndorraUnited Arab EmiratesArgentinaArmeniaAmerican SamoaAntarcticaFrench Southern TerritoriesAntigua and BarbudaAustraliaAustriaAzerbaijanBurundiBelgiumBeninBonaire, Sint Eustatius and SabaBurkina FasoBangladeshBulgariaBahrainBahamasBosnia and HerzegovinaSaint BarthélemyBelarusBelizeBermudaBolivia, Plurinational State ofBrazilBarbadosBrunei DarussalamBhutanBouvet IslandBotswanaCentral African RepublicCanadaCocos (Keeling) IslandsSwitzerlandChileChinaCôte d'IvoireCameroonCongo, the Democratic Republic of theCongoCook IslandsColombiaComorosCape VerdeCosta RicaCubaCuraçaoChristmas IslandCayman IslandsCyprusCzech RepublicGermanyDjiboutiDominicaDenmarkDominican RepublicAlgeriaEcuadorEgyptEritreaWestern SaharaSpainEstoniaEthiopiaFinlandFijiFalkland Islands (Malvinas)FranceFaroe IslandsMicronesia, Federated States ofGabonUnited KingdomGeorgiaGuernseyGhanaGibraltarGuineaGuadeloupeGambiaGuinea-BissauEquatorial GuineaGreeceGrenadaGreenlandGuatemalaFrench GuianaGuamGuyanaHong KongHeard Island and McDonald IslandsHondurasCroatiaHaitiHungaryIndonesiaIsle of ManIndiaBritish Indian Ocean TerritoryIrelandIran, Islamic Republic ofIraqIcelandIsraelItalyJamaicaJerseyJordanJapanKazakhstanKenyaKyrgyzstanCambodiaKiribatiSaint Kitts and NevisKorea, Republic ofKuwaitLao People's Democratic RepublicLebanonLiberiaLibyaSaint LuciaLiechtensteinSri LankaLesothoLithuaniaLuxembourgLatviaMacaoSaint Martin (French part)MoroccoMonacoMoldova, Republic ofMadagascarMaldivesMexicoMarshall IslandsMacedonia, the former Yugoslav Republic ofMaliMaltaMyanmarMontenegroMongoliaNorthern Mariana IslandsMozambiqueMauritaniaMontserratMartiniqueMauritiusMalawiMalaysiaMayotteNamibiaNew CaledoniaNigerNorfolk IslandNigeriaNicaraguaNiueNetherlandsNorwayNepalNauruNew ZealandOmanPakistanPanamaPitcairnPeruPhilippinesPalauPapua New GuineaPolandPuerto RicoKorea, Democratic People's Republic ofPortugalParaguayPalestine, State ofFrench PolynesiaQatarRéunionRomaniaRussian FederationRwandaSaudi ArabiaSudanSenegalSingaporeSouth Georgia and the South Sandwich IslandsSaint Helena, Ascension and Tristan da CunhaSvalbard and Jan MayenSolomon IslandsSierra LeoneEl SalvadorSan MarinoSomaliaSaint Pierre and MiquelonSerbiaSouth SudanSao Tome and PrincipeSurinameSlovakiaSloveniaSwedenSwazilandSint Maarten (Dutch part)SeychellesSyrian Arab RepublicTurks and Caicos IslandsChadTogoThailandTajikistanTokelauTurkmenistanTimor-LesteTongaTrinidad and TobagoTunisiaTurkeyTuvaluTaiwan, Province of ChinaTanzania, United Republic ofUgandaUkraineUnited States Minor Outlying IslandsUruguayUnited StatesUzbekistanHoly See (Vatican City State)Saint Vincent and the GrenadinesVenezuela, Bolivarian Republic ofVirgin Islands, BritishVirgin Islands, U.S.Viet NamVanuatuWallis and FutunaSamoaYemenSouth AfricaZambiaZimbabwe I hereby consent to the collection, storage and use of my personal data for the registration and participation in the "2023 International Conference on Complex Acute Illness ICCAI" from September 8. – 10., 2023 in Augsburg by the Augsburg University Hospital Institute for Digital Medicine (IDM) Stenglinstr. 2 86156 Augsburg Email: email@example.com Tel.: +49 821/400-9520 1. The following personal data are collected and processed: a) Personal details/data (first and last name, address data, professional status data, email address, telephone number and IP address for the registration process), Image captures (if consent is given). b) Bank data (e.g. PayPal or credit card institute and number). 2. Data transfer: Your personal data will be transferred to a third country/international organization (Society for Complex Acute Illness/USA). The above data, if collected, will be stored on the servers of the Society forComplex Acute Illness (SCAI)/USA and will be made available to UKA as the organizer of the congress for preparation and implementation. In order to maintain data protection adequacy, standard contractual clauses have been concluded with SCAI between data controllers and processors in accordance with Article 28 (7) GDPR. Nevertheless, the possibility may exist that unknown third parties (e.g. intelligence services, etc.) access personal data. This existing risk cannot be excluded by the precautions taken. For this reason, the information requested to provide personal data is limited to the minimum necessary. Your data (name, professional status) will be passed on to the German Research Foundation DFG to obtain funding for the congress and, if requested, to the Bavarian Medical Association BLÄK for crediting of continuing education points. 3. Declaration With my registration, I consent to the processing and disclosure of my personal data to the above-mentioned third parties. I am aware of my rights, in particular to revoke this consent, and have become aware of them through the handed over/linked information requirements according to Art. 13 GDPR. I can revoke this consent at any time in writing (Augsburg University Hospital, Institute for Digital Medicine, Stenglinstr. 2, 86156 Augsburg, Germany) or by email (firstname.lastname@example.org) with effect for the future. * Required Please leave this field empty.