Basic Course – Registration Form – FZTH 2019 – ICLO Teaching and Research Center

Basic Course – Registration Form – FZTH 2019

Open Registration

Course Info

Date: 22/06/2019
Language: inglese

Venue: Verona
CME ITA Credits: No

Days: 1 Giorni

Information

BASIC COURSE • JUNE 22
€ 1.400,00 VAT INCLUDED

REGISTRATION FEE INCLUDES:
NR. 1 NIGHT IN 4* HOTEL WITH B&B TREATMENT ON 21ST JUNE
WORKS ON SPECIMEN ON 22ND
INSURANCE FOR THE ENTRANCE INSIDE THE WET LAB
CONGRESSUAL AND SURGICAL MATERIAL
CATERING SERVICE
CERTIFICATE OF ATTENDANCE

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Registration Form

Following your kind request, you will be contacted by the Organizing Secretariat to complete the registration process.

Course

Location

Date

PARTICIPANT INFORMATION

Name

Surname

Birth Date

Birth Place

Address

City

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Province

Mobile Phone

Phone

Fiscal Code

Work

Notes

BILLING INFORMATION

(Fill in only if different from registration data)

Business Name

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City

CAP/ZIP Code

Province

Fiscal Code

VAT number (Mandatory if exist)

Phone

PLACE OF WORK

Place of Work

Address

City

CAP/ZIP Code

Province

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Basic Course – Registration Form – FZTH 2019

Course Info

Information

Registration Form

ICLO Verona s.r.l.