Your name*:
Your address*:
Your email address*:
Your phone number (cell)*:
Name and address of your institution*:
HMAA / HMAA Hungary Chapter membership*: I am HMAA HC memberI am not HMAA HC memberI am HMAA member (USA)
Presenter. Please select which ticket(s) you would like to purchase. (Registration fee) [uacf7_product_dropdown* uacf7_product_dropdown-414]
Additional extra tickets for accompanying persons. If you bring you someone with you without congress registration, you can purchase food tickets for them. [uacf7_product_dropdown uacf7_product_dropdown-296]
For which days do you need lunch? Registration fee incl. lunch for friday and saturday in the restaurant of the Hospital. In the cart you can tick how many lunch you need. I need lunch for FridayI need lunch for Saturday
Dietary requirements:
Additional needs:
Companion name / Name for invoice:
Address of your company:
Contact telephone number:
Comments:
