4th IPLeiria International Health Congress

Registration

In case you have difficulties in completing the application form please contact us via email: fin.health@ipleiria.pt


Fields marked with * are mandatory


1. Personal Information

(Please insert your full name according to your identification card.)
(Please enter the designation of the company or institution where you develop your professional activity.)
(Please insert your email address. The address introduced will be used for future communications)

Best comunnication awards

(Only for presenting authors)




2. Invoice Information

Please fill in the fields below if you require the invoice in a different name from above-mentioned.


3. Registration Summary

Description
Price
Qt.
Total
TOTAL:
0.00 €

4. Payment Method


Address IPLeiria:

Instituto Politécnico de Leiria

Rua General Norton de Matos

Apartado 4133

2411-901 Leiria

Portugal


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Note: After you select the credit card payment method and submit the application form, you will receive an email for credit card payment instructions.





Payment by Bank Transfer to:
Instituto Politécnico de Leiria
R. General Norton de Matos
Apartado 4133
2411-901 Leiria

Bank Name:
Instituto de Gestão da tesouraria e do Crédito Publico, IP
Avenida da República, N.º 57, 6º
Place: Lisboa
Postal/Zip Code: 1050-189
Country: Portugal
NIF: 503 756 237
Phone: +351 217 923 300
FAX: +351 217 993 795

NIB: 078101120000000133640
IBAN: PT50078101120000000133640
SWIFT BIC CODE: IGCPPTPL

For bank transfers, the description of the transfer must comply with the following format: "Health2018+Registration Number".

A copy of the payment/transfer should be sent by e‐mail to the Conference Organizing Committee - fin.health@ipleiria.pt.

5. Submit Registration

I declare that all informations provided on this Application Form are true without any omission to the same. *