Logistics Support: The Pathology of Melanoma: An International Course

Titre*

Dr
Pr
Mr
Mrs

Family name*

First name*

Cell phone number*

Cell phone number (only) Please indicate in front of your phone number, the country dialling code of your country.

E-mail*

Accommodation

Hôtel*

Night of April, 20th (20th to 21st)
Night of April, 21st (21st to 22nd)
Night of April, 22nd (22nd to 23rd)
Night of April, 23 rd (23 rd to 24th)
I don't need accommodation

This package includes a single room with breakfast for four nights at the hotel.
The organising committee will pay for 4 nights on Wednesday 20, Thursday 21, Friday 22 and Saturday 23 April. The extra night and any kind of extras (double room, etc.) are at your expense, to be paid directly at the hotel reception.

Transport

Please send your bank details and transport receipts to the attention of :
l.sarafian@comnco.com
We will reimburse you by bank transfer within 4 weeks of the conference, up to a maximum of €2000, excluding non-refunded catering.

Various

Special requests

Personal information

By sending this form, I agree that my personal data may be used in the context of my logistic support and the providers relation that may result from it.

Name

Ce champ n’est utilisé qu’à des fins de validation et devrait rester inchangé.

Logistics Support: The Pathology of Melanoma: An International Course