Registration Deadline: 22 March 2021 Registration Form For registration and accommodation, please fill out the following form. Mandatory fields are marked with an asterisk (*). General InformationFirst Name*Last Name*TitleInstitution/HospitalPlace and Date of Birth (DD/MM/YYYY)*Address*City*Postal/Zip Code*Country*Phone NumberMobile Number*Fax NumberEmail* Fiscal Code (Italians only)Registration FeesFULL REGISTRATION FEES (VAT included)*The registration fee includes: access all presentations and session recordings, visit the virtual exhibition hall and e-poster area, network with colleagues through live chat and Q&A, join the debate, earn CME credits, free registration for the VIP 2021 Virtual Congress.ESCVS MemberFree of chargeESVT MemberFree of chargeResidents, Trainees & StudentsFree of chargeESCVS Non-Member € 180,00Developing Country Registration Fee € 100,00Technician, Nurse € 50,00Exhibitor, Industry Professional € 100,00TOTAL 0,00 € 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!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.mailCancellation Policy Cancellation after February 26, 2021: no refund. Cancellation notice must be made by e-mail to the Organising Secretariat: info@fc-eventi.com Refunds will be processed after the Congress. 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.Terms of ParticipationTerms of Participation*The personal data you provide will be used to register you for this event. By completing this registration form, you accept the Terms & Conditions and the Data Collection Consent for 6Connex.Yes, I understand that my information will be processed and shared with the aforementioned parties in order to process my registration.No, I do not want my information processed and shared with the aforementioned parties and understand I will not be registered.CAPTCHA
