Registration Form

*Please fill in this form to register your interest in attending the 5th International Conference on Interventional Pain Medicine & Neuromodulation due to take place at the Medical University of Warsaw on 30 June - 1 July 2017. For further information, contact: ciaranwazir@gmail.com
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question