Registration Form – Michael Feldman

Dr. Michael Feldman

Clinical Seminar in Lisbon | 26th to 27th October 2018

Registration Form

BANCO SANTANDER TOTTA, S.A.
Hospital Sta. Maria. Av Egas Moniz, 1600-035 Lisboa-Portugal
Teresa Flores - Clinical Seminar
Account: 000346997151020 31 BT
NIB: 0018000346997151020 83
IBAN: PT500018000346997151020 83
Swift Code/BIC:TOTAPTPL

Upload a copy of the payment

Registration will be confirmed by email upon receipt of completed form and corresponding payment copy. No refund will be available.

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