CONGRESS ...>>>... Individual application form                                                                       

 

 

The 4th International Congress of the Polish Resuscitation Council


 

Participant personal data:

Second Name
First Name
Scientific title
Place of work

Street and number
Zip code

City
Telephone number
Fax
E-mail
 

Congress participation fee:
  

 

Invoice:
Complete the following form for invoice purpose (optional):

Company / Name

TIN

Street and number

Zip code

City

 

Notices: