Erasmus MRI Course Head & Neck 2023

Personal Information

Data protection agreement (required)
Your agreement is required in order to process your registration. Your contact details are held in a secure manner for the purposes of Erasmus MRI Course Head & Neck 2023 administration.

Please indicate YES to proceed with your registration*

* Mandatory fields

Title

Name *

Institution *

Address *

Postal Code

City *

Country *

Phone

Fax

Email *

Username *

Password *

(Please create a Username and a Password so you can later edit your booking)

I agree to the information on this form being stored in an electronic format by Abreu Events for the purposes of Erasmus MRI Course Head & Neck 2023 administration. *

Data for Billing Receipt/Invoice Copy Data

The following information is going to be printed in the receipt/invoice. This information cannot be changed after the receipt has been issued. Please verify if all the details are correct.

Name *

Address *

Postal Code *

City *

Country *

VAT Number *

VAT Number: If not applicable, for Portugal insert: 999999990, for other countries insert: 000000000.

Registration

CANCELLATION POLICY:
• Cancellation is not refundable

	Unit Value	Quantity	Total Value
Registration *
Online Participation	€ 400.00

REGISTRATION FORM

Please choose an option:

Personal Information

Data for Billing Receipt/Invoice Copy Data

Registration

Services Summary

Payment


Discount Code