Participant Registration Form
XIIIth National Forum of Healthcare Professionals with International Participation
"Healthcare - present and future"
10-11th November 2017
Shumen, Bulgaria
Full Name *
Your answer
Professional Identification Number
Your answer
Personal Identification Number or Passport Number *
Your answer
Place of Residence / Country, Town, Address *
Your answer
Current Job *
Your answer
Phone Number *
Your answer
E-mail *
Your answer
Type of Participation *
Registration fee *
Required
Paid Fee *
Please write down the number and date of the payment order for paid participation fee.
Your answer
Official Dinner - 30 leva *
I would like to receive an invoice *
Invoice Details
Your answer
This registration form is filled in by each participant regardless of whether they present a report, a poster, or they are in co-autorship.
The participants organize their stay on their own during the conference !
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