REGISTRATION FORM

To be returned by SEPTEMBER 10, at the latest

 

Company

Name:

Address:
Postal Code:
City:
Country:
Telephone:
Mobile phone:
Fax.:
e-mail:
URL:

What do you expect from MEDIMED ’12?
   
   

Flight details:

  
Arrival
I come from
Flight number
Flight arrival time
Air Company:
Departure:
I go to
Flight number
Flight departure time:
Air Company:
   
Hotel in Sitges
 
 

Please, note that a Participation Fee of 390,00 EUR is requested, which includes:
- accreditation, printed catalogue, MEDIMED handbag
- welcome pica-pica (Friday)
- catered lunch and dinner-party (Saturday)
- buffet (Sunday)
- open bar at the venue
- translation service English/French
ON SITE PRICE (October 12-14): 480 EUR

You are kindly requested to transfer in advance the amount of 390,00 EUR the following APIMED banking account Nr. 
(R.I.B.): IBAN ES58 0182-4162-24-0011503292  with BBVA Bank, Barcelona, Spain.  SWIFT: BBVAESMMXXX

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