REGISTRATION FORM

6th European School of Dermato-Oncology


Please fill in your name, city and country carefully as it will be used for printing your name badge.
First Name*:
Last Name*:
Gender:
Speciality:
Institution*:
Address*:
City*:
Zip Code*:
Country*:
Daytime Telephone:
Fax:
E-Mail*:

Fees

Registration Fee of 380,00 Euro (incl. VAT) covers
  • Admission to scientific sessions
  • Admission to exhibition
  • Bag with course documents
  • Welcome reception
  • Coffee breaks and lunch
  • Certificate of Attendance

Payment Method

Bank Transfer:
Bank Transfer
(Registration can only be confirmed upon receipt of full payment)
Credit Card: MasterCard
Visa
American Express
Credit Card Number:
Expiration Date (MM/YY):
Security Code CCV: MC/Visa - 3 digits on back; AMEX - 4 digits on front
Cardholder Name:

Invoice Address (if different from above)

If the invoice address is different from the address given above, please fill in your invoice address below. Please note that for the rewriting of invoices 20 per invoice will be charged.
First Name:
Last Name:
Institution:
Address:
City:
Zip Code:
Country:

By completing the registration form, the participant accepts the general terms and conditions as well as the cancellation policy given on the congress website and agrees that his/her data may be used, processed and published (e.g. within the list of participants) for organizational purposes of the event. The participant accepts that MedConcept will contact him/her by email for organizational matters (e.g. the registration confirmation and invoice) and information related to the event.

 

I accept until further notice that MedConcept will inform me about future events by email.

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