REGISTRATION FORM FOR WORKSHOPS

Please fill in the form and send it by mail  to [email protected]

Mr/Ms/Mrs/Dr/Pr :       Student               ( étudiant)      Scholar  (enseignant)       Professional (professionnel)

First Name (prénom) :                                                                 Last Name (Nom) :

University (Université) :                                                                             Country (Pays) :             

Phone number (Téléphone):

Email Address:

Title of the Workshop  ( check on the web site    https://eahl2019.sciencesconf.org  ) 

 

Registration fee for one workshop:  25 euros

Payment in cash upon arrival   yes   no           or by check to ARFDM      yes     no

Or by bank transfer    yes  no                     to ARFDM  :

ARFDM Association de Recherche et de  Formation en Droit Médical

Code Banque 30004  Code Guichet 00765  Numéro de compte 00010041167     Clé RIB   68

IBAN :  FR76 3000 4007 6500 0100 4116 768

BIC (Bank Identification Code) : BNPAFRPPTLS