Registration form - Event on November 29-30, 2010 – Barcelona (Spain)

 

 Required fields marked *
Title:*
First name:*
Last name:*
Job Title:*
Company:* invoice name
Company: name to show on web-site
Department:
Address 1:*
Address 2:
City:*
State/Province:
Postal code:*
Country:*
Tel.:* include country code
Mobile Tel: location during the event
Fax:* include country code
E-mail:*
Repeat E-mail:*
Web site:
Fiscal identification Nº:  VAT Nº
Note: 18% VAT partially applicable to companies with valid VAT Nº (EU companies), valid fiscal identification Nº or company registration Nº (non-EU companies). Full VAT tax applies to companies without fiscal identification.

Registration type:

Administrative contact: (Additional partcipants need to complete a separate registration form)
 
Title assistant:
First name:
Last name:
E-mail:

Invoice address: (only if different from above)


Payment method: Bank Transfer
  (A pro-forma invoice with payment details will be sent shortly)
Credit Card (Visa, MasterCard, Amex)

Comments:
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 If you do not receive a confirmation within three days, please contact us at info@pharmavenue.com or send us the registration form by fax to: +34933969237.