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IBUS UPDATE IN BREAST IMAGING 2012 PARTICIPANTS ON LINE REGISTRATION FORM

 

IMPORTANT NOTES:


Please note that your REGISTRATION will only be valid when full payment is received by the ADMINISTRATIVE OFFICE.

 

Payment done by BANK TRANSFER must be certified with the COPY of the RECEIPT of the bank to be UPLOADED in the registration form or sent to e-mail to convegni@unife.it or faxed to +39 0532 767347.

For BANK TRANSFER:

Please make drafts payable in Euro to:

Account Name: CONSORZIO FERRARA RICERCHE

Bank Details: Unicredit Private Banking - Via Frizzi 21 - 44121 Ferrara, Italy

Account Number: 1326114

IBAN: IT 87 W 02008 13009 000001326114

SWIFT/BIC: UNCRITMM

  • Please ensure IBUS 2012 - NAME SURMANE of the participant are stated on the REASON of the bank transfer
  • Bank charges are the responsability of the participant and should be paid at source in addition to the registration

 

10% discount for EUSOBI, SIRM and SIUMB MEMBERS will be accepted only if a copy of the 2012 membership payment proof is uploaded by this form or sent to convegni@unife.it or faxed to +39 0532 767347 at the time of the registration.

REGISTER NOW!!!


PERSONAL INFORMATION
Personal information are strictrly required for the CME report which we are obliged to provide to the Ministry of Health at the end of the Course.
DATE OF BIRTH  
/ /  
PLESE SPECIFY YOUR TYPE OF OCCUPATION  




INVOICE DATA
TYPE OF COURSE AND REGISTRATION FEE
Important notes: Payment must be made in Euros only. Registration must be accompained by the full payment.
DISCOUNT REQUIRED   PLEASE SELECT AMONG THESE OPTIONS
METHOD OF PAYMENT
Important notes: Payment must be made in Euros only. Registration must be accompained by the full payment.
ACCOMMODATION DETAILS
Hotel bookings will be made directly by the Secretariat upon requests made and preferences expressed by this form. Hotel payment is the responsibility of registrants and shall be made directly to the hotel upon departure. Reservations will only be confirmed if credit card details are fully supplied as a guarantee of the hotel booking. Each participant will receive an individual confirmation letter, indicating the name and the address of the Hotel.
IF YES PLEASE SPECIFY:
Credit card details must be fully provided in order to proceed for the hotel booking and as a guarantee of the booking itself
PRIVACY POLICY - Informational statement according to article 13 of Legislative Decree 196/2003 (Code on protection of personal data) Information and personal data are collected through the voluntary compilation of the form and are used for the purpose of the participation at the Course. The data collected can be memorized both in electronic and paper format and will be used by us respecting all the measures provided by law for the safeguarding of the rights of the interested parties.The giving of data is optional; possible refusal to provide this data could mean the inability on our part to send the information requested and process your registation to the Course. Data will be used also with electronic devices and may be used for administrative, fiscal and/or commercial activity. We will not pas data to unauthorized third parties. Responsibility for the use of data is Consorzio Ferrara Ricerche, Via Saragat 1, 44122 Ferrara (FE). You should act for your right as stated in art. 7, by sending an e-mail to cfr@unife.it.
I HAVE READ AND AGREE WITH THE ABOVE STATEMENT  

 


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