I International Congress on Vascular Access - Registration Form
Welcome to the I International Congress on Vascular Access!

The first phase of registrations will end by the 31st of May of 2019.

Please, fill all of the fields below. If any information is missing, your registration will be considered invalid. Also, proceed to the payment in 24 hours after sending the form.

APoAVa members will earn a 15% on the congress price (Note that Workshop/Pre-congress prices are not considered for discount purposes).

For more information, please contact us through the following e-mail: congresso@apoava.pt

Thank you and enjoy the event!

The CIAV2019 TEAM

ATTENTION: APoAVa will never share or use the data provided on this form for other purposes than CIAV2019 logistic and management.

Personal Data
Full Name *
Your answer
Institution *
Your answer
Phone Number *
Your answer
E-mail *
Your answer
Member of APoAVa *
Required
Registration Options
Choose the option that most suits your preferences.

You can pay your registration using the following NIB 0043.0001.04001072951.73

Please, attach the proving of your payment to congresso@apoava.pt with the Subject «CIAV2019 Payment [Your Full Name]»

Professionals (until 31st of May)
Professionals (after 31st of May)
Students (before 31st of May) (Note: please attach the proof if your are currently studying)
Students (after 31st of May) (Note: please attach the proof if your are currently studying)
Nutritional and Food Preferences
Invoice Details
Name
Your answer
Street Address
Your answer
Zip Code
Your answer
NIF/VAT Number
Your answer
Pre-Congress Courses
The three courses are held at the same time (8h30). Please, only choose one course to attend.
*
Required
Congress Dinner (26th of september) *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service