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
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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
Select the payment method:
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:

Registration Fees*

Registration Fees