REGISTRATION FORM:
   Biomaterials and Novel Technologies for Healthcare, 2nd International Biennial Conference BioMaH
   
    Period : 8th October 2018 - 11th October 2018
    Location :
   On-line Registration will be available until 8th October 2018
 
   Family Name *
   
 
   Name *
   
 
   Place of Birth *
   
 
   Date of Birth *
   
 
    Codice Fiscale /VAT number
   
 
   Profession/Specialization *
   
 
   Institute
   
 
   Personal address *
   
 
   City *
   
 
   Postal Code *
   
 
   Nation
   
 
   Mobile *
   
 
   E-mail Invitation letter for VISA (Yes/No)
   
 
   Intolerances/food allergies (please specify) *
   
 
   GLUTEN FRRE
    Yes No
 
   
   
 
   
   
 
   
   
 
    Privacy
   
    I have read and I accept the above conditions
 
   Note:
   BIOMAH + Family Name
 
Select Option
Before 31/08/2018
Before 08/10/2018
After 08/10/2018
Regular Registration Fee
€ 400,00
€ 550,00
€ 0,00
Students (social dinner not included)
€ 200,00
€ 250,00
€ 0,00
1 day Registration
€ 200,00
€ 200,00
€ 0,00
 
Select Optional Features
I intend to partecipate with Oral presentation
€ 0,00
I intend to partecipate with Poster
€ 0,00
I intend to partecipate with Other
€ 0,00
Social Dinner Accompanying person
€ 55,00
Social Dinner Students
€ 55,00
 
Payment Mode

Bank Transfer:
Owner : MI&T SRL
IT71I0638502403100000004376
Swift Code/Bic Code IBSPIT2BXXX
Description: BIOMAH + Family Name

Credit Card (CartaSi, Visa, Visa Electron, Mastercard, American Express)
 
Amout to pay: