:: Over Media Consult ::

Rural Health 2010

eULIS 2009 - 15th-17th october 2009 - Lake of Como

• You can register online: please complete the form below

- Personal information is mandatory.
- If you have already registered in other conferences on this site, you are a registered user and you can recall your personal information. Click on "My personal information", insert your username and password that are sent to you in email, and return to this form. -> "My personal information".
- If you don't remember your username and password, click on --> "Request my personal information".

ONLY REGISTRATION ON-SITE

Personal information
DR.:
Last name:		First name:
E-mail:		Codice fiscale (Italy only)
Private address:		City:
State or province:		Country:
ZIP postal code:
Degree (or Equivalent):		Primary professional occupation:
Institution information
Institution, company or organization name:
Institution for badge (if different from above):		Department:
Address:
City:		State or province:
Country:		ZIP postal code:
Telephone number with country & city codes:		Fax number with country & city codes:
Registration category
Until June 30th 2009		After June 30th 2009
Accompaying Person - (100 EUR Until June 30th 2009, 150 EUR after June 30th 2009):	Please specify No. of people
Social Dinner - (60 EUR VAT excluded):	Please specify No. of people
Arrival date (dd-mm-yy):		Departure date (dd-mm-yy):
Additional names:
Payment information
1. Money transfer to: Holder: Over Media Consult Srl -Via Manini 31 - 26100 Cremona Description: eULIS 2009 + Name and Surname IBAN IT59W0845411400000000085323 SWIF CODE: ICRA IT MM CM 0 2. Credit Card: Mastercard, VISA
Law 675/96 for the safeguard of your personal information: Over Consult s.r.l. will dispose of the above mentioned information to send the symposium program and to be modified or uptodated. Any changes will be notified.

OVER MEDIA CONSULT s.r.l.

Via Manini, 31 - 26100 CREMONA

Email: info@overconsult.it - Tel. 0372 23310 - Fax: 0372 569605

P.IVA 01279400194