REGISTRATION FORM:
   RE-LIVE RESURGE 2021 - 7th edition
   
    Period : 7th May 2021 - 7th September 2021
    Location :
   On-line Registration will be available until 7th September 2021
 
   Note:
   The Secretariat will send you a request of payment through Paypal after the registration: you can pay with your Paypal account or credit card.
 
   Family Name
   
 
   Name *
   
 
   Place of Birth *
   
 
   Date of Birth *
   
 
   ID (fiscal code) *
   
 
   VAT number
   
 
   Profession/Specialization *
   
 
   Institute
   
 
   Professionale address
   
 
   Personal address *
   
 
   City *
   
 
   Town *
   
 
   Postal Code *
   
 
   Nation
   
 
   Phone *
   
 
   Mobile *
   
 
   Fax
   
 
   Intolerances/food allergies
   
 
   E-mail *
   
 
    Privacy
   
    I have read and I accept the above conditions
 
Select Option
Before 18/05/2021
Before 18/05/2021
After 18/05/2021
Re-live video access
€ 183,00
€ 183,00
€ 183,00
 
 
Payment Mode

Bank Transfer:
Owner : MI&T SRL
IT71I0638502403100000004376
Swift Code/Bic Code IBSPIT2BXXX
Description:

Credit Card (CartaSi, Visa, Visa Electron, Mastercard, American Express)
 
Amout to pay:
 
 
Note:
The Secretariat will send you a request of payment through Paypal after the registration: you can pay with your Paypal account or credit card.