Registration form

REGISTRATION METHOD

By cash at arrival in Chisinau - In this case the Conference participant must present in advance to the Organizing Committee the Guarantee Letter confirming that the payments will be made at arrival in Chisinau.

By bank transfer - the payments must be effected before June 15, 2011. The name of organization, country, city and name of participant should be indicated in Payment Order. Beneficiary: Asociatia Obsteasca Societatea de Inginginerie biomedicala din Moldova fiscal cod 10096200001096

Chisinau Studentilor 9/7
acc. EUR 22511642846
BC Moldova Agroindbank S.A

BRANCH "Miron Costin"
SWIFT:AGRNMD 2X 710
CORESPONDENTS BANKS

COMMERZBANK AG, Frankfurt am Main, Germany
SWIFT: COBA DE FF
EUR A/C: 400 8865297- 01

REGISTRATION FORM

Fields marked with an asterisk * are required.

Surname: *
First Name: *
Institution: *
Department: *
Address: *
ZIP: *
Country: *
City: *
Fax: *
E-mail: *
Paper Title: *
Authors: *