SIM 2018 Congress Registration Form
Surname *
Your answer
First Name *
Your answer
Title
Dr, Mr, Mrs, Ms
Your answer
Hospital *
Your answer
Address *
Your answer
Postal Code *
Your answer
City *
Your answer
Country *
Your answer
1. Billing address: University, Hospital, Establishment or Company *
Your answer
2.Billing address: Organization number or VAT number *
Your answer
3. Billing address: Postal address or e-mail address *
Your answer
4. Billing address: Reference number (if applicable) *
Your answer
E-mail address *
Your answer
Participation in social programme on Wednesday June 6th *
Wednesday: " Allas Sea Pool Get Together"
Participation in social programme on Thursday June 7th *
Archipelago Cruise
Participation in lunch on Friday June 8th *
Special Diet *
Your answer
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