Registration
form
Personal data
Surname Name Born on atJob title / area of interest Affiliation / Company Home address
Zip Code City
State Cell Phone Email address
I wish to register to
Before September 30 After September 30❍
PICC Day
¤ 200
¤ 250
❍
Congr. GAVeCeLT
¤ 250
¤ 300
❍
PICC Day
+
Congr. GAVeCeLT
¤ 350
¤ 450
Payment
❍
I enclose copy of bank transfer
The order of: Millennium Events
Banca Popolare dell’Emilia Romagna - Roma Succursale I
IBAN IT07Z0538703209000002290962
BIC/SWIFT BPMOIT22XXX
Personal data will be handled with maximal confidentiality, according to the Italian law 675/96 about privacy. They will not be disclosed to third parties and will be cancelled any time if requested.
date signature
Dcember 1st
l
9th PICC Day
International meeting
focused on PICCs
and Midline catheters
December 2-3
l
9th Congresso
GAVeCeLT
The Science
of Venous Access
Event organized in collaboration withCongress
Secretariat
Millennium Events srl Via Konrad Adenauer, 18 00061 Anguillara Sabazia (RM) P.IVA e C.F. 13091811003T + 39 06 01902533 F + 39 06 3221853
info@millenniumevents.it
