Enrollment

Congress *
Consultant / Specialist (350Euro+VAT)
Resident / Doctor in training (250Euro+VAT)
Medical Student (150Euro+VAT)

Home address    or    Institution address*

First name, Last name*

Academic title(s) *

Institution/University *

Department/Clinic *

Street, Number *

Postal Code, Place *

Country *

Phone

Fax

E-Mail *

Friday, June 10^th, 2022: Welcome cocktail (included for participants)

Friday, June 10^th, 2022: Welcome cocktail for maximum 1 accompaniment Person (+25 Euro)

Saturday, June 11^th, 2022: GALA DINNER with WINE TASTING (included for participants)

Saturday, June 11^th, 2022: GALA DINNER with WINE TASTING for maximum 1 accompaniment Person (+60 Euro)

Agreement for processing personal data *