TEST

    REGISTRATION FORM

    PAYMENT
    Bank payment procedure: After receiving your completed registration form, we will send you an offer within 48 hours to make your payment.

    NOTE:
    Be sure to fill in all fields marked with an asterisk.

    CONTACT PERMISSION
    By registering for the congress, I give my permission to Vivid original Ltd. to contact me about the congress, as well as all other similar meetings related to the medical profession. You will be able to contact Vivid original Ltd. and withdraw this permission at any time.

    CANCELLATION AND REFUNDS
    Terms of cancellation
    • All cancellations of Congress registration, which must include your full bank account details, should be sent in writing to the Congress Agency Vivid Original Ltd. Cancellations received no later than July 01, 2021 will be refunded in full except VAT and administrative fee of 10% after the Congress.
    • Cancellations received after July 01, 2021 will not be refunded.

    Title*

    Last name*

    First name*

    Institution*

    Institution address*

    ZIP code*

    City*

    Country

    Phone*

    Mobile phone*

    E-mail*

    Choose type of registration*
    Regular participant / 350€ / 2625KnResident / 270€ / 2.025KnNurse / 200€ / 1.500KnDay ticket* / 150€ / 1.125KnAccompanying person / 100€ / 750Kn

    *If Day ticket please specify for wich day (MM/DD/YYYY)?

    Social event

    Lunch option - per day

    PAYER’S INFORMATION
    Payer’s name*

    Payer’s PIN*

    Payer’s Address*

    ZIP Code*

    City*

    Country*

    Payer’s E-Mail*

    Input this code: captcha

    For new registration please repeat the registration process.