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Personal Data

Title ^*

Name ^*

Badge Name ^* Please fill in the badge name

E-mail ^*

Telephone Number ^* Please fill in the telephone number

Professional Category ^* Please fill in the professional category

Specialty ^* Please fill in the specialty

Workplace ^* Please fill in the workplace

Internal Observations Please fill in the observations

* Mandatory Fields

Billing Information

Name ^* Please fill in the name (billing information)

TIN ^* Please fill in the VAT (billing information)

E-mail ^*

Address ^* Please fill in the address (billing information)

Postal Code ^* Please fill in the postal code (billing information)

Place ^* Please fill in the city (billing information)

Country ^* Please fill in the country (billing information)

* Mandatory Fields

Registration Details

Registration Type

Specialists

Residents and Other Healthcare Profissionals

Payment Details

Amount to Pay: 300,00 €

Payment Method: Wire TransferEuPago Reference

Registrations Inclued:

- Vat;
- Access to all scientific sessions and trade exhibition;
- Coffee breaks and lunches;
- Congress documentation;
- Certificate of attendance.

* I accept that my personal data is saved and processed for any purpose related to the event 'Lisbon Stroke Summit'. The data in question will be kept until otherwise indicated in writing to privacidade@eventbase.pt by the titleholder.

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