SMART - Registration

Apply your registration

Fill in the form below to apply your registration.

Personal Information

Title*

Name*

Surname*

Email*

Date of birth*

City of birth*

Province of birth

Country of birth*

CF/SSN (If you're not Italian resident, please flag SSN)

CF SSN

Fiscal Code (for Italians only)*

Sponsor Full

Professional/Academic Information

Profession/Discipline

Hospital/University/Company

Department

Address Hospital/University/Company

Hospital Country

Hospital City

Contact Information

Office Phone

Mobile Phone

Registration fees *

SMART TALKS - 30€

Invoicing (mandatory data to be entered)

Name and Surname/Company*

Street/Road*

No*

Postal Code*

City*

Country*

Vat Code*

FISCAL CODE (only for Italy)*

Codice Univoco / PEC (for Italians only)*

Payment

CREDIT CARD

By submitting this form, you agree to our Terms of Use and Privacy Policy and data protection guidelines *

I would like to receive newsletters from the Organizing Secretariat

RELOAD