For registration and accommodation, please fill out the following form. Mandatory fields are marked with an asterisk (*). 1. General InformationFirst Name*Last Name*TitlePlace and Date of Birth (DD/MM/YYYY)*Address*City*Postal/Zip Code*Country*Phone NumberMobile Number*Fax NumberEmail* Fiscal Code (Italians only)2. Details for InvoiceName of Individual, Company or Organization*Address*City*Postal/Zip Code*Country*VAT ID Number/National Insurance Number*SDI Code (Italians Only)Certified E.mail3. Early Bird Registration, Social Events & Accommodation Fees (until 31 December 2020)EARLY BIRD REGISTRATION FEES (VAT included)*The registration fee includes: access to all scientific sessions, access to the exhibition area, congress kit and attendance badge, final programme, certificate of attendance, box lunch, welcome cocktail.ESCVS Active/Full Member € 500,00ESCVS Non-Member € 700,00ESCVS Junior Member and Abstract Presenter € 185,00Trainee Non-Member € 300,00Med.Technician, Perfusionist, Nurse € 100,00Exhibitor, Industry Professional € 300,00One Day Registration Fee € 250,00WORKSHOPRegistration to the Workshops is mandatory and subject to availability (maximum 20 people each). Please choose the workshops you wish to attend: WORKSHOP 1 "Percutaneous arterial closure systems" - Friday 26 March 2021 (09.00-10.00) WORKSHOP 2 "Percutaneous endoluminal tromboaspirations procedure" - Friday 26 March 2021 (15.00-16.00) WORKSHOP 5 "Graft infections" - Saturday 27 March 2021 (11.00-12.00) WORKSHOP 6 "Carotid artery disease" - Saturday 27 March 2021 (17.30-18.30) WORKSHOP 9 "Vein sclerotherapy" - Sunday 28 March 2021 (09.00 - 10.00) SOCIAL EVENTS (VAT included) Welcome Cocktail - March 26, 2021Included Social Dinner - March 27, 2021€ 70,00 Welcome Cocktail - March 26, 2021 Price: 0,00 € Social Dinner - March 27, 2021 Price: 70,00 € HOTEL RESERVATION RATES (VAT included)All rates are per room, per night and include breakfast. Hotel Reservation rates do not include Local City Tax, per person/per night. Hotel Category 4 Stars: € 3,00 | Hotel Category: 3 Stars € 2,00. Cash on site.Hotel 3*** - Single/DUS€ 90,00Hotel 3*** - Double€ 110,00Hotel 4**** - Single/DUS€ 130,00Hotel 4**** - Double€ 150,00I don't need any Hotel ReservationBooking Fee per room (VAT 22% included) Price: 25,00 € Number of Nights*Check-in*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Check-out*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920TOTAL 0,00 € 4. Payment MethodPayment Method*Bank TransferPay Online with PayPal or Credit CardFC EVENTI Srl BANK: BANCO BPM SPA ADDRESS: Via Guerrazzi 32 – 40125 Bologna, Italy IBAN: IT94T0503402437000000000077 BBAN: T0503402437000000000077 BIC: BAPPIT21208 DESCRIPTION OF PAYMENT: “ESCVS 2020 REGISTRATION DR. (LAST NAME)” Bank charges are the responsibility of the payer. Please note that registration will not be effective until payment of the registration fee has been received by the Organising Secretariat.Please, upload copy of the bank receipt*Accepted file types: jpg, gif, png, pdf, doc, docx, jpeg.When you click the submit button you will be directed to PayPal to complete your payment!5. Cancellation Policy Cancellation before January 31, 2021: full refund minus € 50,00 - handling fee. Cancellation after January 31, 2021: no refund. No-shows will not be refunded. Cancellation notice must be made by e-mail to the Organising Secretariat: info@fc-eventi.com6. Privacy and Treatment of Personal DataConsent* I have read the Privacy Policy and consent to the use of my personal data for the purposes specified therein.CAPTCHAName First Last
