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4rd International Congress of Polish Resuscitation Council


 

Data of Company participating in the Congress: (state on 25.06.2009)

The Company’s full name*

Street and number*
ZIP code*
city*
NIP*
Phone No.
Fax
E-mail
* All fields with star are required

 

Form of Company participation in the Congress:

  sponsored session

  advertisement in the program

  workshop

  promotional materials

  sponsored lecture

 

 

 

  stand

 

If number of persons servicing the stand exceeds above mentioned limits, the fee for each additional person is equal to the conference fee at the settlement day.

 

 Number of stand servicing representatives  :

 

Names of stand servicing persons:

1

3

5

7

9

2

4

6

8

10

 

Data of authorised person for contact with the Congress Organizing Committee:

Name*

Mobile phone No.*

Stationary phone No.*

Fax

E-mail*

Notes