4th NEUROMED SKULL BASE COURSE WITH 3-D EXOSCOPES – HANDS-ON COURSE

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Course attending *4th NEUROMED SKULL BASE COURSE WITH 3-D EXOSCOPES – HANDS-ON COURSE

NOME CORSO

Course date *14-15 February 2025

DATA CORSO

First Name and Last Name *

First

Last

Address *

INDIRIZZO

Tax ID Number *

CODICE FISCALE

Date and place of birth *

DATA E LUOGO DI NASCITA

Phone

TELEFONO

Email Address *

INDIRIZZO MAIL

Place and year of specialization *

LUOGO E DATA SPECIALIZZAZIONE

Billing Information

DATI FATTURAZIONE

Arrival Date

DATA ARRIVO

Departure Date

DATA PARTENZA – IF YOU NEED A VISA, SEND A COPY OF YOUR PASSPORT.

Submit

registration fees (NON- REFUNDABLE):

PARTECIPANT: 1.098,00 € VAT INCLUDED

OBSERVER: 305,00 € VAT INCLUDED

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

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

TO SUBMIT  SEND THE APPLICATION AND RECEIPT TO: cadaverlab@neuromed.it

* The Neuromed Necroscopy Center is a no profit Laboratory. All the economic entries received are
used for research and training activities related to the Laboratory