PDSTM 2016

Registration

Passport number or ID card:

Name:

Family name:

Sex: Male Female

Telephone

Institution: (as will appear in your badge)

City:

Country:

E-mail

Re-enter E-mail:

Please select your category: Student Doctor / Professor

Arriving day:

Before Lunch Before Dinner After Dinner

Departure day:

Before Lunch Before Dinner After Dinner

Accommodation: Single room Double room

I will take part on the Sunday excursion to Guadalest and Altea:
Yes40€ fee includes transportation, lunch and any other cost related to the event.
No

Invoice: Yes No

Invoice to:

Address:

Zip Code:

City:

Country:

VAT number:

Comments:

Organized by:

Other sponsors: