REGISTRATION SHEET


MT3 Update: Nuevos avances en Medicina transfusional y terapia celular y tisular
 
     
 
The gaps with asterisk (*) must be filled
 
PERSONAL DATA
Name (*)    
1st Surname (*)    
2nd Surname     
Sex (*)     Woman     Man
Date of birth (*)     Day Month Year
ID Card (*)                   NIE  Passport 
Address (*)    
City (*)       C.P.(*)  
Country (*)      
Nationality (*)    
Telf. (*)         Celular phone     Fax  
Email (*)        
Academic degree (*)    
Type of academic degree (*)    
Department/Office     
Job     
Payment      Bank Transfer

Price for alumni of the Master of Transfusion Medicine: 475€
External: 675€.

Banco de Sabadell
IBAN: ES81 0081 0407 1800 0112 6221
SWIFT: BSABESBB

Without the bank transfer's attachment you can not enroll in the course.
Must indicate the name and title of the conference
Attached file     
 
In accordance with the provisions of Law 15/1999, of December 13, Protection of Personal Data, please note that the data entered in this form, and those that can pick up or make themselves in the future, arising from the legal relationship is maintained incorporated in the file / files internal database owned by the Fundació Salut i Envelliment in order to manage the training activities that the person executed with the foundation, also will be used by informed of new offers for training and festive greetings. If the training is accredited by the UAB, the data can be transferred from the person above-mentioned organization in order to formalize the process of accreditation and registration. Also, please note that you can exercise your rights of access, rectification, opposition and cancellation policy contacting the Fundació Salut i Envelliment address c / St. Antonio Maria Claret No. 171, 08041. If you don't want to receive more information about new formative offers or festive greetings you can send and email or by another equivalent way of communication.