Registration
form
Personal data
Surname Name Born on atJob title / area of interest Affiliation / Company Home address
Zip Code City
State Cell. Phone E-mail address
Before September 15 After September 15
❍
GAVeCeLT 4-5/12
€ 300 + iva (€66)
€ 350 + iva (€77)
❍
GAVeCeLT 4-5/12
+
PICC Day 6/12
€ 350 + iva (€77)
€ 450 + iva (€99)
❍
PICC Day 6/12
€ 250 + iva (€55)
€ 300 + iva (€66)
December 4-5
10
th
GAVeCeLT
Congress
December 6
11
th
PICC Day
International meeting
focused on PICCs
and Midline catheters
Location
Firenzefiera
Palazzo dei Congressi
Piazza Adua 1, Florence, Italy
I wish to register to
This form must be filled and forwarded
to Millennium Events
(by fax, email or surface mail)
Florence 2017
December 4 / 5 / 6
Congress
Secretariat
Millennium Events srl Via Konrad Adenauer, 18 00061 Anguillara Sabazia (RM) P.IVA e C.F. 13091811003
T + 39 06 01902533 F + 39 06 3221853
Payment
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
