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Section 1 of 1
Formulario de registro (Estudiantes FEEF) "EPSA 10th Atumn Assembly"
Modalidad de inscripción
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1.
Inscripción al programa científico del congreso (50 euros)
2.
Inscripción local completa, programa científico+programa social (150 euros)
3.
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Nombre
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Apellidos
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Sexo
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1.
Female
2.
Male
3.
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Dirección postal completa
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Código Postal
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Ciudad
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Email
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Repite tu email
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Teléfono móvil
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Fecha de nacimiento
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Nacionalidad
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Tipo de documento
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1.
DNI
2.
Pasaporte
3.
NIE
4.
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Número del documento
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Fecha de caducidad
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Año de estudio
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Facultad
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Universidad
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Miembro de AVEF
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"Sí" o "No"  soy socio de la Asociación Valenciana de Jóvenes Estudiantes de Farmacia, en caso de "No" serlo se cobrarán 5 euros como tasa de asociación
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1.
Si
2.
No
3.
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Contacto de emergencia
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Nombre completo
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Relación
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Teléfono
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Teléfono móvil
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Email
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Dirección
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Código postal
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Ciudad
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Restricciones alimentarias
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Sin
Vegetariano
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Alergias conocidas
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Otra información relevante sobre la salud
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Usted recibirá un email de confirmación de registro, desde registration@epsa-aa2013.com con la confirmación oficial. Por favor, lea los términos y condiciones
Question Type
Garantizo la veracidad de los datos recogidos en este formulario. Por otra parte, he leído y entendido este formulario de registro y acepto todos los términos establecidos en esta página.
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Acepto
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add "Other"
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Modalidad de inscripción
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Nombre
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Apellidos
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Sexo
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Dirección postal completa
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Código Postal
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Ciudad
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Email
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Repite tu email
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Teléfono móvil
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Fecha de nacimiento
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Nacionalidad
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Tipo de documento
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Número del documento
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Fecha de caducidad
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Año de estudio
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Facultad
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Universidad
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Miembro de AVEF
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Contacto de emergencia
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Relación
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Teléfono
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Teléfono móvil
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Email
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Dirección
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Código postal
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Ciudad
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Restricciones alimentarias
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Alergias conocidas
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Otra información relevante sobre la salud
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Usted recibirá un email de confirmación de registro, desde registration@epsa-aa2013.com con la confirmación oficial. Por favor, lea los términos y condiciones
Copy
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