EIGHTH
INTERNATIONAL COURSE
ON PERITONEAL DIALYSIS
REGISTRATION FORM
DEADLINE: APRIL 30, 2003
REGISTRATION FORM
DEADLINE: MAY 30, 2002
Name __________________________________________________________________________
Surname ________________________________________________________________________
Address _________________________________________________________________________
________________________________________________________________________________
Affiliation ________________________________________________________________________
________________________________________________________________________________
City ____________________________________________________________________________
Country _________________________________________________________________________
Tel. ____________________________________________________________________________
Fax ____________________________________________________________________________
E-mail __________________________________________________________________________
Invoice to: ___________________________________________________________________________
____________________________________________________________________________________
I herewith enclose a copy of Bank Transfer of 650 €
Registration forms without copy of bank transfer will not be accepted.
The
total amount for registration has been payed to:
NEW PROGRESS SERVICE s.r.l.
Banca Intesa BCI - AmbroVeneto
Filiale di Porta Padova, 51/53 - Vicenza
Account n. 10020/66
IBAN IT42 D030 6911 8320 0000 1002 066
SWIFF-BAVE IT MM 902 ABI 03069 CAB 11832
Send to: STUDIO dr. Anna Saccardo
Via Bertesina, 394 36100 - Vicenza - Italy
Fax (39) 0444 - 993949 or 303088