Biomedical Technologies

Identification details

Please complete this section accurately.
* = compulsory field

FAMILY NAME

FIRST NAME

TITLE

INSTITUTION/ORGANIZATION

DEPARTMENT

PERSONAL ADDRESS

CITY

ZIP CODE

STATE/PROVINCE

COUNTRY

FOR ITALIANS ONLY !
inserire il codice fiscale

E-MAIL ADDRESS

TELEPHONE
(country code, city code, number)

- - *

FAX
(country code, city code, number)

FOR ITALIANS ONLY !
inserire numero di appartenenza all’ordine

ACCOMPANYING PERSON 1
(Family Name, First Name)

ACCOMPANYING PERSON 2
(Family Name, First Name)

Billing details

Fill this part only if your Billing details are different from your Identification details.
* = compulsory field

BILLING HEADING

BILLING ADDRESS

VAT NUMBER

FOR ITALIAN COMPANIES ONLY !
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FOR ITALIAN COMPANIES ONLY !
inserire la partita IVA

CITY

ZIP CODE

STATE/PROVINCE

COUNTRY

PLEASE PROVIDE A PHONE NUMBER FOR INVOICES QUERIES
(country code, city code, number)

IMPORTANT NOTICE: If a different heading is not specified in the Billing Details, the invoice will be made out according to the information provided in the Identification Details section.

Registration Fees (EURO, 20% Vat included)

	Until 30/06/2010	After 30/06/2010
DON'T Register for the Congress	€0.00	€0.00
ISPOG Members Medical	€400.00	€450.00
ISPOG Members no Medical	€300.00	€350.00
Delegates Medical	€450.00	€500.00
Delegates no Medical	€400.00	€450.00
Midwife*	€200.00	€250.00
Students and Residents*	€150.00	€200.00
Workshop - Childbirth and Anxiety	€100.00	€100.00
Workshop - Intervention against abuse in health care	€50.00	€50.00
Accompanying Person	€120.00	€120.00
Gala Dinner	€120.00	€120.00
*Midwifes,residents in training, nurses and technicians. Official certificate must be submitted

DON'T Register for the Congress		€0.00
ISPOG Members Medical		€450.00
ISPOG Members no Medical		€350.00
Delegates Medical		€500.00
Delegates no Medical		€450.00
Midwife*		€250.00
Students and Residents*		€200.00
Workshop - Childbirth and Anxiety		€100.00
Workshop - Intervention against abuse in health care		€50.00
Accompanying Person		€120.00
Gala Dinner		€120.00
*Midwifes,residents in training, nurses and technicians. Official certificate must be submitted

Payment details

Please check the appropriate box and process the payment referring to the instructions appearing in each method of payment.
Registrations will be considered as confirmed only upon receipt of the payment.

Check :: Bank Transfer:: Credit Card or PayPal::

REGISTRATION FEE FOR THE DELEGATE INCLUDES
Opening Ceremony, Closing Ceremony, Access to all sessions and exhibition area, Congress kit, Abstract Book, CME credits and/or ECM credits, Password to access the Congress on-line.

CANCELLATION POLICY FOR REGISTRATION
Refunds (less € 25,00 for taxes and administrative expenses) will be granted to delegates unable to attend. A written notice must be received by the Organizing Secretariat before August 30th, 2010. No refunds will be made for cancellations received after August 30th, 2010. All refunds will be issued after the Congress.

PERSONAL DATA PROTECTION - LAW N. 196/2003

Personal data collected directly and/or through third parties by controller and processor Biomedical Technologies, Main Office in Cagliari Via Cugia 1, are processed in printed, computing and telematic form for fulfilling contractual and lawful obligations as well as for the effective handing of business relations. The email addresses provided may be used by Biomedical Technologies to send advertising materials on events similar to those subject of the present business relations. The non-submittal of data, where not compulsory, will be evaluated from case to case by the controller and the resulting decisions to be made will take into account the importance of the required data in respect of the business relations, management. Data may be disclosed in Italy and/or abroad, strictly in accordance with the above-mentioned purposes, and consequently processed, only in relation to the mentioned purpose, by other persons: professionals and consultants as well as by persons allowed to access to your personal data according to National or Community regulations. If necessary, for the above-mentioned reasons, your data may be disclosed to third parties. For the same reasons, our partners and/or employees may process your data in their capacity of executors or processors. The persons concerned may exercise all the rights set forth in art. 7 of L.n. 196/2003 (including the rights of data access, corrections, updating, objects to data processing and cancellation). The processor "pro tempore" is the legal representative of the company.

Do not accept