ATHENS MEDICAL SOCIETY

ATTIKON University General Hospital, ATHENS

Form

ΑΤΗΕΝΑ International Conference
Athens, November 19th-21th, 2019

Final Form

Last name(*)
Please let us know your lastname.

First name(*)
Please let us know your lastname.

Email(*)
Please let us know your email address.

Category(*)

Select the category where you belong

Invalid Input
 
Gender(*)
Invalid Input

Date of Birth(*)
Invalid Input

Medical Specialty(*)
Invalid Input

Country(*)
Invalid Input

Contact phone number(*)
Invalid Input

Fax number
Invalid Input

Mobile phone number(*)
Invalid Input

Institution (name and address)
Invalid Input

License Number
Invalid Input

Sponsor contact details (if applicable)
Invalid Input

Select your registration fee(*)

Please select appropriately

Invalid Input
Do you want to arrange an accommodation for you?(*)

We can arrange an accommodation for the delegates

Invalid Input
 
Accommodation for 2 nights: Check-in 28/11/ 2017, Check-out: 30/11/ 2017

Additional accommodation night
Invalid Input

Room Type (Single Use)(*)
Invalid Input

Booking made(*)
Invalid Input

Would you like to receive flight suggestions as well?(*)
Invalid Input

Additional Comments
Invalid Input

 

PAYMENT PROCEDURE

Thank you for participating in ATHENA International Conference!

We would like to inform you that a 50%, non refundable, deposit of the total amount is required by Saturday, July 15, 2017.
The remaining balance should be paid by Monday, October 30, 2017. The date may change if it is previously arranged upon.

---------- TOTAL AMOUNT ----------


Please select the best preferred payment method (*)

Beneficiary
KEGM TOURIST AND CONGRESS OPERATIONS S.A.
(KEGM TOURISTIKES & SYNEDRIAKES EPIHEIRHSEIS A.E.)
Bank Name
ALPHA BANK
Bank's Address
Athens Tower- Branch 112 (Pyrgos Athinon)
Account No
194-00-2320-001285
IBAN
GR77 0140 1120 1940 0232 0001 285
SWIFT CODE
CRBAGRAAXXX

(in Bank deposit description, it should be written: ATHENA Conference,………Full Name……)


(VISA, VISA Electron, MasterCard, Maestro, AmericanExpress)

Please, fill in the data for Receipt or Invoice issuing appropriately

Full Name(*)
Invalid Input

Country(*)
Invalid Input

Name of Company(*)
Invalid Input

Full Address of Company(*)
Invalid Input

Specialty(*)
Invalid Input

VAT(*)
Invalid Input

Tax Office(*)
Invalid Input

City(*)
Invalid Input

Country(*)
Invalid Input

Copyright © 2019 ATHENA International Conference. Design by PlanTech