Registration

Forum of Cities and Regions Registration Form– Rzeszow on 4-6th June 2019/Forum Miast i Regionów Formularz Rejestracyjny Rzeszów 4-6 czerwca 2019

Type of Participant/Typ Uczestnika:

Head of the delegation/Przewodniczący delegacji:

A form of courtesy/Zwrot grzecznościowy:

Name/Imię:

Surname/Nazwisko:

Position/Stanowisko:

Institution/Instytucja:

Organizational unit/Jednostka organizacyjna:

Date & time of arrival/Data przyjazdu:

Arrival by/Przyjazd:

If you arrive by car, fill plate number/Jeśli przyjedziesz samochodem, podaj numer rejestracyjny:

Do you need parking place?/Zapotrzebowanie na miejsce parkingowe:

If you arrive by plane, fill flight number/ Jeśli przylatujesz samolotem, podaj numer lotu:

If you arrive by train, fill train number/Jeśli przyjeżdżasz pociągiem, wpisz numer pociągu:

Location of arrival/Miejsce przyjazdu:

Time & date of departure/Data i godzina wyjazdu:

Departure by/Wyjazd:

Please, fill the plane or train number/ Proszę wpisać numer samolotu lub pociągu:

E-mail adress/adres e-mail:

Telephone number/numer telefonu:

Address (street, city, postal code)/Adres (ulica, miasto. kod pocztowy):

What are your dietary requirements? Do you have any food intolerance?/Czy ma Pan/Pani specjalne preferencje żywieniowe (nietolerancja, alergie, etc.)?:

Please chose one of parallel panels which you will be attending on the 6th of June/Proszę wybrać jeden z równoległych paneli, w których Pan / Pani będzie uczestniczyć 6 czerwca:

Will you attend planned cultural activities?/Czy będzie Pan / Pani uczestniczył w planowanych wydarzeniach kulturalnych?:

Will you be participating in (choose one or more options)/Czy będzie Pan/Pani uczestniczyć w:

reception on the 4th of June/przyjęciu organizowanym przez Marszałka 4 czerwca

sightseeing of the Lancut castle/zwiedzaniu zamku w Łańcucie

Gala dinner on the 5th of June/uroczystej kolacji 5 czerwca

Please be informed that transport will be provided by the Ministry of Investment and Economic Development during the Forum (Rzeszow-Jasionka - Lancut Castle)/Informujemy, że lokalny transport będzie zapewniony przez Ministerstwo Inwestycji i Rozwoju (hotele w Rzeszowie - Jasionka - Zamek w Łańcucie)

If you have special needs resulting from disability, please mark appropriate accommodation/Jeśli ma Pan/Pani szczególne potrzeby wynikające z niepełnosprawności prosimy zaznaczyć właściwe udogodnienia:

hearing aid system/Zapewnienie systemu wspomagającego słyszenie:

sign language interpretation/Zapewnienie tłumacza języka migowego:

assistant to a person with a disability/Wsparcie asystenta osoby z niepełnosprawnością:

Other/inne:

Please indicate the person who we will contact in organizational matters. Please write a form of courtesy, name, surname as well as phone and e-mail of contact person/ Proszę wskazać osobę, z którą skontaktujemy się w sprawach organizacyjnych:

Information clause regarding the processing of personal dataInformation and contact details regarding personal data

The Controller of personal data: The Minister of Investment and Economic Development, Wspólna 2/4 St., 00‑926, Warszawa, e-mail kancelaria@miir.gov.pl

Data Protection Supervisor – e-mail iod@miir.gov.pl

Information on the processed personal data

The purpose of data processing is to register and participate in the Conference of Cities and Regions Forum as part of the Polish Presidency of the Berlin Process and to carry out information and promotion activities related to the implementation and conduct of the conference.
The legal basis for data processing is your consent, expressed in accordance with Art. 6 para. 1. a) of the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of individuals with regard to the processing of personal data and on the free movement of such data and repealing Directive 95/46 / EC (general regulation on data protection), (Journal of Laws of the EU L of 4 May 2016, No. 119), hereinafter referred to as the GDPR / RODO.
Personal data will be processed for the following period of time:
1. data contained in the registration form will be processed until the end of 2019.
2. data in the form of image will be processed throughout the period of existence of the website of the Ministry of Investment and Economic Development.
Categories of the processed data: those indicated in the registration form and personal data of the conference participants in the form of image recorded in a photo, will be processed for informational and promotional purposes related to the implementation and conduct of the conference.
Providing personal data is voluntary, but it is necessary to attend the conference.
The consequence of not providing personal data may be a lack of the possibility to register / participate in the Forum.

Recipients of the personal data.

The data may be entrusted for processing:

entities providing to the Minister of Investments and Economic Development services in the scope of management and development of ICT networks
entities participating in the Forum organization

The rights of the data subject

You have the right to:

request from the Data Controller to access your personal data, rectify them, delete or limit their processing,
withdraw consent to the processing of personal data at any time; the withdrawal of consent shall not affect the lawfulness of processing based on consent before its withdrawal,
receive your personal data in a structured commonly used format, transferring this data to other administrators or request, if it is technically possible, to be sent by the administrator to another administrator,

The request to implement the aforementioned rights should be sent in writing to the Data Controller (the address given at the beginning of this information clause, with the note "Personal data protection") or in electronic form to the following address iod@miir.gov.pl.

You have the right to lodge a complaint to thePresident of the Personal Data Protection Office.

Information about automated decision making, including profiling

Personal data will not be subject to automated decision making, including profiling.

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Forum of Cities and Regions Registration Form– Rzeszow on 4-6th June 2019/Forum Miast i Regionów Formularz Rejestracyjny Rzeszów 4-6 czerwca 2019

Will you be participating in (choose one or more options)/Czy będzie Pan/Pani uczestniczyć w:

If you have special needs resulting from disability, please mark appropriate accommodation/Jeśli ma Pan/Pani szczególne potrzeby wynikające z niepełnosprawności prosimy zaznaczyć właściwe udogodnienia:

Klauzula informacyjna