Send the registration form and a copy of payment to Fax n. 0039 06
registrAtion Fees Send the registration form and a copy of payment to Fax n. 0039 06 3233304 or to [email protected] registrAtion Form name Surname Address city code e-mail Phone Fiscal code date of birth mobile / / inVoiCe inFormAtion company Address city e-mail Phone VAT number State Full Congress registrAtion Fee (18-19-20 june) qSurgeon and dentist Before April 30 th Courses Fee cloSed number qmicro Surgical endocourse (Prof. Kim) qSinus elevation course (Prof. Testori) Before April 30 th 120,00+VAT 22% 120,00+VAT 22% 300,00+VAT 22% 390,00+VAT 22% the registration fee entitles you to: - participation in only one of the symposia provided daily (please select your choice) - simultaneous translation where applicable - conference kit and entrance to the exhibition - coffee break - certificate of attendance symposium preFerenCe qendo-operative Symposium june 18th june 19th qPerio-implant Symposium qortho-prostho Symposium june 20th Place of birth After April 30th After April 30th 150,00+VAT 22% 150,00+VAT 22% qregenerative Symposium qmultidisciplinary Program qmultidisciplinary Program CAtering lunCH for 3 days q € 75,00 lunCH DAily q € 25,00 gAlA reCeption q € 35,00 code State mobile pAyment All payments must be made in euro. You can choose between two forms of payment, either credit card payment or bank transfer. We strongly recommend the credit card payment as charges for bank transfers may apply twice, once in the country of origin and a second time in the target country. • CreDit CArD: q Visa q Mastercard card Holder _____________________________________ number _______________________________exp. date___________ Security number_____ A bank fee of 5% will be applied on each payment. • BAnk trAnsFer to tHe Congress BAnk ACCount: medIcon ITAlIA conGreSSI Srl - banca Popolare di milano Ag. 260 iBAn: it 46 u 055 6 8403 2090 0000 0008 249 BiC (sWiFt-CoDe): Bpmiitm1260 bank address: Via cassia 901 – 00191 roma (rm) - Italy qregistrAtion Fee............. qCourses............. qlunCH pACkAge.............. qgAlA reCeption € 35,00 ConFirmAtion totAl to pAy € ....................... upon receipt of the registration and the corresponding payment, the congress office will send a confirmation to the participant which also serves as an invoice. Please show this confirmation of registration at the congress counter when picking up your congress material. CAnCellAtion In the event that the attendance at the congress is cancelled 15 days before the event, the participant will be entitled to a refund of 50% of the amount paid. no refund will be made if the registration is cancelled at a later date. Please notify the organizing Secretariat of your cancellation in writing. refunds will be made within 60 days from the closing date of the congress priVACy inFormAtion Information ex Art. 13 of the civil code in matters of personal data (legislative decree 30 June 2003, n. 196 - consolidated the rules on the protection of persons and other subjects regarding the processing of personal data) The common information and data provided by you for entry to this event will be processed in accordance with the above provisions and obligations of confidentiality that inspire the activities of medicon Italia congressi srl. The data processing will be carried out to give way to his inscription, sending of information by our company, administration and non-accounting. The approval of the treatment is optional, but in case of lack thereof medicon Italia congressi srl will not be able to deliver all or some of the services covered by this registration. For a more vision please refer to the dl 196 / 2003e of the content of Articles. 13:07. q i give my consent to the processing of my personal data. q i do not give the consent to the processing of my personal data, except to this event to the treatments required statutory. date / Signature /
© Copyright 2024