Congresso de Medicina Oral e do Sono - 13 e 14 de março
Place: Aula Magna - Lisbon School of Medicine, Universidade de Lisboa | PORTUGAL
Address: Av. Professor Egas Moniz, 1649-028 Lisbon
Host: AIDFM - Associação para Investigação e Desenvolvimento da Faculdade de Medicina
Contacts: +351 217 985 173 |
* Required
Title
*
Professor
Doctor
Other:
Name
*
Your answer
Address
*
Your answer
Post code
*
Your answer
Country
*
Your answer
Phone
*
Your answer
Email
*
Your answer
Affiliation
*
Your answer
Position
*
Your answer
PAYMENT
*
Wire Transfer to AIDFM - (IBAN - PT50 0018 0000 3666 5472 0018 0 | BIC/SWIFT: TOTAPTPL) - After the operation please do send the proof of your payment to the following email:
newfrontiersincardiomyopathies@gmail.com
In Cash: AIDFM, Av. Prof. Egas Moniz - Piso 01 1649-028 Lisboa
Receipt Name
*
Your answer
VAT number
*
Your answer
Next
Page 1 of 2
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
