Rome, Italy  
May 12-14, 2010  

On-line Services

(*) required field PERSONAL DETAILS Title (*)   Prof. Dr. Mr. Mrs. Ms.   First name (*) Family name (*) Profession (*)   Fellow Physician Speciality (*) Organization / Company (*) Institute / Department (*) ALBO Number (only for Italian) Fiscal Code (*) Date of birth (*) // Place of birth (*)   ADDRESS Street (*) Number (*) City (*) ZIP (*) Code Country (*) Phone (*) Mobile (*) Fax (*) Email (*)   BILLING ADDRESS Company VAT n° (*) Billing type (*)   Personal Sponsor Street (*) City (*) Zip (*) Code country (*) Phone (*) Mobile (*) Fax (*) Email (*)     Registration Fees (VAT 20% included) 3 days fee € 660,00 Fellows Free registration All fees are requested in Euro. Registration will be processed only if accompanied by total payment. The registration fee includes admission to all scientific sessions, badge and congress kit, certificate of attendance, CME certificate, EBAC certificate, coffee breaks and lunches. Method of payment (*)   Bank Transfer Credit Card (PayPal service)   Cancellation policy Notification of cancellation must be sent in writing to Devital Service SpA. Cancellations received by the Organizing Secretariat before March 30, 2010 will be refunded except for a 30% administration charge. No refunds will be made for cancellations received after this date. All approved refunds will be processed and issued after the Forum. CANCELLATION BEFORE MARCH 30, 2010: 30% of the registration fee will be withheld CANCELLATION AFTER MARCH 30, 2010: No Refund   Privacy (*) D.lgs 196/03 “Unique text in subject of protection of the personal data”. Devital Service SpA is the responsible of the treatment of your data; your data will be treated with the purpose to manage your participation at the congress. In relationship to the treatment of the data, D.lgs 196/03, in every moment you can practice towards Devital Service SpA, responsible of the treatment, the rights specifically anticipated from the art. 7 of the D.Lgs. 196/03 and in the formalities contemplated.   Accept    Not accept