2ND EUROPEAN MYELOMA NETWORK MEETING

individual registration

Step 1

YOUR DATA

Enter your e-mail and proceed

E-mail*

Step 2

PERSONAL DETAILS

Name*

Surname*

Phone number please specify the country code

Address*

ZIP*

Nation*

City*

Birth date*

Birth place*

Fiscal code*

Career*

Discipline*

Institute

I would like to receive the invoice addressed to:

Company Detail

Agency / Individual Name*

SDI Code / PEC Address (for italian company only, digit dot to continue)*

VAT Number*

Fiscal Code*

Address*

ZIP*

City*

Province*

Nation*

Payment Method

Credit Card / PayPal

Bank tranfer to:

Studio E.R. Congressi

Credit Agricole Cariparma SpA

Via Largo Caduti del Lavoro, 1/A

40122 Bologna

Italy

SWIFT BIC Code: CRPPIT2P564

IBAN CODE: IT05A0623002400000056773590

ACCOUNT NO. 56773590

payment amount