First Name*

Last Name*

Email*

Event Name*

Presentation name* If there is more than one presentation, write all the names separated with a comma.

Request*
—Please choose an option—Remove Exposed Patient DataRemove PublicationsRequest for DeletionAccessRectificationErasureRestrictionPortabilityObjectionWithdrawal of ConsentOther

Comment Please provide a detailed description of your request and the context in which the data is involved.

Supporting Documents Attach any supporting documents that can help in verifying your request (e.g., emails, screenshots).

Declarations*

Additionally, you must confirm that you have contacted the conference organisers and received no response. You can also authorise our Data Protection Officer to take immediate action on your behalf if your privacy rights have been violated or if patient data has been exposed.
I declare that I have contacted the conference organisers with my request. There was no response within a reasonable term.

Immediate Action Authorisation*

I grant the Data Protection Officer the right to take immediate action on my behalf if there is a violation of my privacy rights or exposure of patient data.