Registration

Registration confirmation will be sent to the email address provided on this form.

NAME

SURNAME

NATIONALITY

E-MAIL

ADDRESS

MIDDLE NAME

DEGREE

DATE OF BIRTH

PHONE NUMBER

COUNTRY

NUMBER OF YEARS IN PRACTICE

IF YOU HAVE AN INVITATION CODE, PLEASE ENTER IT BELOW

MOREOVER, IF YOU WOULD LIKE TO PARTICIPATE, OR IF YOU ARE ALREADY REGISTERED TO MLCTO (Multi - Level CTO Endovascular Course) AND CLI (Global Society), YOU WILL RECEIVE A 30% DISCOUNT ON REGISTRATION TO IMENDOFORUM AND THE CONFERENCE OF YOUR CHOICE.

MLCTO 30%

CLI 50%

If you tick this box, you thereby agree that your personal data (Consisting of name, contact data, address data & organization/institute), collected by XCorporate Group Srl, may be forwarded (via a contracted service provider) to the exhibitor/sponsor, and the respective company may contact you directly for its own purposes (e.g. by email concerning products, services and events that may be of interest to you). If you would prefer that this information not be disclosed to our exhibitors, please send a written request to remove your information from the lists. Send your request to: secretary@imendoforum.com

I have read and acceptes the Terms & Conditions

You have registered successfully!

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