REGISTRATION:
Specialist physicians.................. 475 euros   Resident physicians .................... 400 euros
VAT included

Surname:   Name:

Address:

City:   Province:   Postal Code:

Telephone:   Fax:   Tax Id.:

E-Mail:

Work Centre:   Position:

City:   Province:   Postal Code:

Telephone:   Fax:   E-Mail:

METHOD OF PAYMENT:
Personal cheque payable to: “XI Curso de Actualización en Cirugía de la Mano”
Bank transfer to Caja Cantabria
      Account num.: 2066 0003 56 0200030445
      Holder : “XI Curso de Actualización en Cirugía de la Mano”

Once payment has been made, please send proof of payment to the following FAX number: +34 942 31 07 97 or E-mail address: gordaliza@nexopublicidad.es