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NOME CORSO
DATA CORSO
First Name and Last Name
INDIRIZZO
CODICE FISCALE
DATA E LUOGO DI NASCITA
TELEFONO
INDIRIZZO MAIL
LUOGO E DATA SPECIALIZZAZIONE
DATI FATTURAZIONE
DATA ARRIVO
DATA PARTENZA - IF YOU NEED A VISA, SEND A COPY OF YOUR PASSPORT.

registration fees (NON- REFUNDABLE):

PARTECIPANT: 610 € VAT INCLUDED

 (hotel **** for 2 nights, social dinner AND attendance certificate)

VENAFRO PALACE HOTEL

SS 85 Venafrana, 86079 Venafro IS

PAYMENT METHOD: BANK TRANSFER

BANK DETAILS:

NEUROMED spa

BANCO BPM

02481-CAMPOBASSO

IBAN: IT96A0503403801000000004387

SWIFT: bappit21q81

PAYMENT DETAILS: LIST THE TILE OF THE COURSE YOUR ARE ATTENDING