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Personal information
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DR.:
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| Last name: |
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First name: |
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| E-mail: |
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Codice fiscale
(Italy only) |
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| Private address: |
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City: |
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| State or province: |
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Country: |
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| ZIP postal code: |
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Degree
(or Equivalent): |
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Institution information
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Institution, company or
organization name: |
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Institution for badge
(if different from above): |
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Department: |
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| Address: |
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City: |
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| State or province: |
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Country: |
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| ZIP postal code: |
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Telephone number with
country & city codes: |
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Fax number
with country
& city codes: |
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Registration category
- On line through the Organizing Secretariat web site (www.ruralhealth2010.net)
- By fax to +39 0372 569605 together with a copy of the registration fee payment
Upon checking the payment a confirmation will be sent via e-mail
- After 1st Sept 2010 registrations will only be accepted on-site; the organisers might not be able to guarantee the availability of the congress material.
- After 1st Sept 2010 it will not be possible to change already existing registrations.
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Until July 15th 2010
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Accompanying person:
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After July 15th 2010
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Accompanying person:
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Payment (only in EURO Currency)
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1. Bank transfer to Over Media Consult srl:
"Third international Congress on Rural Health in Mediterranean and Balkan Countries"
BANCA CREMONESE - Via del Giordano, 109 - 26100 Cremona
IBAN IT59W0845411400000000085323
SWIFT ICRAITMMCM0
2. Credit Card (Visa o MasterCard), for single registration only
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Invoicing
Registrations will be regularly invoiced. Please indicate clearly name, surname, billing address. |
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Law 675/96 for the safeguard of your personal information:
Over Consult s.r.l. will dispose of the above mentioned information to send the symposium program and to be modified or uptodated.
Any changes will be notified.
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