Dermoscopy Excellence 2021
Limited enrollment - Lessons will be held in English without translation
Registration Form
In order to guarantee your enrollment to the“Dermoscopy Excellence International Masterclass”, please pre-register and fill out the below Registration Form:
Title *
Surname *
Name *
Date of birth *
MM
/
DD
/
YYYY
Email *
Mobile phone
insert international dialing code, es. +39 123456789
INVOICE ADDRESS
Address *
Postal code *
Town/City *
State/Province
Country *
Fiscal Code (equivalent to National Insurance Number or Social Security Number for non Italian residents) *
VAT Number
Please note any special needs or dietary requirements:
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