Summer school Praga 2016
REGISTRATION FORM
SCHEDA DI ISCRIZIONE

Registrations will be accepted after payment of the full amount through bank transfer to:ASSOCIAZIONE MEDICINA DIALOGO COMUNIONE (M.D.C.)IBAN: IT68L0335901600100000113321BIC: BCITITMX
Last name
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First name
Nome
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Country
Nazione
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City
Città
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Complete Postal Address
Indirizzo completo
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ZIP or Postal Code
Codice Postale
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Tel/Phone number
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Data di Nascita
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Profission
Professione
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Faculty of
Facoltà
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Institution
Ente
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Area of interest
Ambito di interesse
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