Registration form

Registration Form
Personal information*

NameSurname
Fiscal code*
If not applicable, please digit 000
Affiliation*
Entity, Hospital, University
Contractual Form*
Selezionare un'opzione tra le voci proposte
Field*
Selezionare un'opzione tra le voci proposte
Please indicate if you have been recruited by a commercial company operating in the healthcare sector:*
A healthcare professional is considered to be recruited if he/she benefits from direct and indirect economic and non-economic advantages from commercial companies operating in the healthcare field for participation in training events,
Please indicate the company
Contact information*

E-mail addressPhone number
Special needs
Please indicate allergies, intolerances, special dietary needs or any other needs
Registration Fees*
prevnext( X )
Whole course - Physician - Fee reserved to AIOCC, SIOeCHCF or SIRM-H&N Group members
Fee valid until 15th June 2025. From 16th June 1.650,00 €

€1,650.00



Whole course - Physician
Fee valid until 15th June 2025. From 16th June 2.200,00 €

€2,200.00



Whole course - Resident - Fee reserved to AIOCC, SIOeCHCF or SIRM-H&N Group members
Fee valid until 15th June 2025. From 16th June 900,00 €

€900.00



Whole course - Resident
Fee valid until 15th June 2025. From 16th June 1.200,00 €

€1,200.00



Single module - Physician - Fee reserved to AIOCC, SIOeCHCF or SIRM-H&N Group members
Fee valid until 15th June 2025. From 16th June 5230,00 €

€382.50



Single module - Physician
Fee valid until 15th June 2025. From 16th June 450,00 €

€450.00



Single module - Resident - Fee reserved to AIOCC, SIOeCHCF or SIRM-H&N Group members
Fee valid until 15th June 2025. From 16th June 213,00 €

€212.50



Single module - Resident
Fee valid until 15th June 2025. From 16th June 250,00 €

€250.00



Two modules - Physician - Fee reserved to AIOCC, SIOeCHCF or SIRM-H&N Group members
Fee valid until 15th June 2025. From 16th June 723,00 €

€722.50



Two modules - Physician
Fee valid until 15th June 2025. From 16th June 850,00 €

€850.00



Two modules - Resident - Fee reserved to AIOCC, SIOeCHCF or SIRM-H&N Group members
Fee valid until 15th June 2025. From 16th June 425,00 €

€425.00



Two modules - Resident
Fee valid until 15th June 2025. From 16th June 500,00 €

€500.00



Three modules - Physician - Fee reserved to AIOCC, SIOeCHCF or SIRM-H&N Group members
Fee valid until 15th June 2025. From 16th June 1.040,00 €

€1,040.00



Three modules - Physician
Fee valid until 15th June 2025. From 16th June 1300,00 €

€1,300.00



Three modules - Resident - Fee reserved to AIOCC, SIOeCHCF or SIRM-H&N Group members
Fee valid until 15th June 2025. From 16th June 600,00 €

€600.00



Three modules - Resident
Fee valid until 15th June 2025. From 16th June 750,00 €

€750.00



Total

€0.00
Note
If chosen one, two or three modules, please indicate which ones you're interested in
Bank transfer (the secretariat will send the details via e-mail)Online credit card (the secretariat will send a personal link via e-mail)
Invoicing information*

Header of the invoice

Fiscal address: street, town, postal code

Date and place of birthVAT number (if applicable)

Any notes
Should be Empty: