Registration Form

Type: Physicians    Physioterapists   Residents
Last name:
Name:
Name for badge:
Institute/Company:
Address:
City/Borough:
State/Province:
Country:
Postal Code:
Phone Number:
E-mail Address:


PAYMENT

The payment is only by bank transfer. You will receive an INVOICE with the
necessary bank information.
NOTE: Please if the INVOICE has to be in the name of your institute/company,
can’t be in your name, please fill in the form bellow:

Institute/Company:
Address:
City/Borough:
State/Province:
Country:
Postal Code:
CNPJ (just for Brazil):


Don’t forget to send to Idealiza Events the payment receipt to confirm your registration: Phone/Fax: 55 41 3016-7175
E-mail: idealiza@idealiza.com.br

IMPORTANT: Your registration will be accepted only if you send us the payment receipt.

Departamento de Urologia

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Eventos