REGISTRATION FORM

Registration Type

  *  
Title  * 
Last Name *  
First Name *  
Date of Birth (dd/mm/yyyy)
Professional role *  
Specialty *  
Main workpalce type *  
Istitution/Company name
Address Line *  
City *  
State (Only for USA, Canada, Mexico, Brazil, India, Australia)
Postcode
Country *  
Mobile Phone * 
Email Address *  
   
Invoice Details  
Invoice Header *  
Invoice Address Line *  
Invoice Address City *  
Invoice Address Postcode *  
VAT or Fiscal Code Number *  
Invoice Address Country *  
 
* = required field
 
Total to Pay:  €
 
SELECT PAYMENT METHOD
 
 
Your registration will be completed as soon as we receive payment of the registration fee. 
Please send us a copy of the payment made so that we can trace it and can confirm your paid registration.
After payment is received you will be sent a new confirmation. Should you have any further queries with regard to your booking please do not hesitate to contact us by email at info@pediatrics20.com
Terms and Conditions


  
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II INTERNATIONAL CONGRESS PEDIATRICS 2.0 - Bilbao September 14 - 16 2017