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Pre-Inscripción al IV Congreso Internacional de Clínica Médica y Medicina Interna de SMIBA 2026
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Nombre y Apellido
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Email
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Sos Médico ?
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SI
NO
Nro de Matrícula ( Solo Médicos )
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Institución
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Nro de Libreta Univeristaria ( Solo Estudiantes )
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País
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Teléfono
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Sos socio de SMIBA ?
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SI
NO
Tenés Beca para el Congreso ?
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NO
De qué Laboratorio o Institución es la Beca?
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