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PARTICIPANT INFORMATION

Name (complete)

Please, insert proof of "Member", "Student" or "Retired".

Short name (for identification card during congress. Maximum 16 characters)

Male or Female?
MaleFemale

E-mail

Institution

Address

Country

Phone Number (including country code)

Pre-congress course |30€|

Only pre-congress course
(If you want to attend only to the pre-congress courses please check this box. Not applicable to accompanying persons)

Special dietary needs

Social Event + Congress dinner |50€|
YesNo

RECEIPT OF PAYMENT INFORMATION

Institution or Name*

VAT number*

Address invoice*

Observations