Gender(*):
female
male
Last name(*):
Title / First name(*):
Profession(*):
Doctor
Doctor in education
Student

(*) obligatory entry


Please fill in your professional AND/OR your private contact data:


Professional contact data Private contact data
 
Institution(*):
Department:
Address(*): Address(**):
Zip code(*): Zip code(**):
City(*): City(**):
Country(*): Country(**):
Phone(*): Phone(**):
Mobile: Mobile:
E-mail(*): E-mail(**):
This field MUST NOT BE filled in!

(*) obligatory entry if you fill out professional contact data
(**) obligatory entry if you fill out privat contact data

For AUSTRIAN doctors only:
 
Please fill in your ÖÄK-Arztnummer and your date of birth:
You can check your ÖÄK-Arztnummer on the website of ÖÄK
(http://abfrage.aerztekammer.at/index.jsf)

ÖÄK-Arztnummer:
Date of birth (dd/mm/yyyy):



I herewith register for the following event:


Integrated Management of Acute and Chronic Cardiovascular Disease, January 27 – 30, 2018

  regular discount ticket/ residents
Full registration € 600,- € 300,-
2-day ticket € 400,- € 200,-
1-day ticket € 200,- € 100,-


PAYMENT


  bank transfer — bank data will be sent with your registration confirmation e-mail
  credit card (VISA or MASTERCARD only) — You will receive an e-mail with payment instructions after submission of this form.




Comments:

I want to get informed about future events.
I don't want to get informed about future events.

Please note that your registration is binding with your submission.
After submission on this form you will receive an automatic e-mail confirming your registration.



We are at your disposal for any questions.

With best regards

Sonja Chmella, Barbara Horak

International Exhibitions & Advertising
Medizinische Ausstellungs- und Werbegesellschaft

Freyung 6/3, 1010 Wien/Vienna, Austria
T +43 (0)1 536 63- 32 oder 34
F +43 (0)1 535 60 16
E
www.maw.co.at

UID-Nr./VAT no.: ATU15098604, Handelsgericht Wien, FN 104324v
Rechnungsadresse/invoice address:
Medizinische Ausstellungs- und Werbegesellschaft Maria Rodler & Co GmbH
Engerthstraße 128, 1200 Wien/Vienna, Austria