PharmSC2 - Medicines Shortages      +++  SEMINAR (03-July-2017)   +++
European Medicines Shortages Research Network - addressing supply problems to patients
                                                 (Medicines Shortages, CA15105)


                                                       REGISTRATION FORM:
                      II SEMINAR on "Pharmaceutical SC - Medicines Shortages"    
                   Auditorium Dr. Francisco Tomatas, ESTG, Portalegre, Portugal
                                                      Monday, 03-July-2017
   


                                  Updates about the progam are made available at
                                                      www.tinyurl.com/PharmSC 



                                             ***** PAYMENT BY BANK TRANSFER *****
                                     (30 €, thirty euros for External non-COST Participants:
                  the payment includes the lunch, 2-two coffee-breaks, documentation, and certificate)

> ACCOUNT NAME: INSTIT.POLITÉC.PORTAL-RECEITAS PRÓPRIAS
   NIB: 078101120000000440451
   IBAN:PT50078101120000000440451
   BIC:IGCPPTPL
   SWIFT BIC CODE:IGCPPTP1
   NIF:600 028 348

 (Please send the ATM or the bank transfer receipt to: cpsd@estgp.pt )




                                                                  ***** CONTACT *****
                                                         FOR SEMINAR REGISTRATION


 Cristina Dias, cpsd@estgp.pt
 Instituto Politécnico de Portalegre (IPP)
 Escola Superior de Tecnologia e Gestão
 Campus Politécnico N10
 7300-555 Portalegre
 Portugal
 Tel: + 351 245 300 200 / + 351 245 300 255
 Fax: + 351 245 300 230




                                                *****  REGISTRATION & PAYMENT *****

> The registration and payment services are provided by IPP Central Services;

> The confirmation of registration occurs after the reception of payment;

> The registration may be cancelled by the participant and the amount (minus administration costs) reimbursed
if and only if the cancellation occurs until fourteen days (14) before the event;



                                                              ***** DEADLINE *****
                                                                    29-June-2017 !

                       
Sign in to Google to save your progress. Learn more
Name (P1) *
Full name
Address (P2) *
Complete post address
Phone Number (P3) *
Complete phone number, with the country code
E-mail (P4) *
Primary e-mail
Affiliation (A1)
Primary instititution/organization for affiliation
Affiliation country (A2)
Country for the institution/organization of affiliation
Denomination for Receipt (R1) *
The receipt is denominated to this person or legal entity
Post address for Receipt (R2) *
Complete post address for receipt purposes
Identification Tax Number (R3) *
Identification Tax Number for receipt purposes
Bank Payment Reference (R4) *
Bank Payment Reference
Verification *
Please verify your answers and chek the boxes
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy