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 Third Middle East Cardiopace


This form is for one participant only. Feel free to re-submit this form for additional participants.

In case you need more info please send an email to executive@trust-traders.com

PERSONAL DATA (Please use CAPITAL letters)

Degree/Title Other title, please specify
*Last Name *First Name
Institution Department
Address
City
*Country 
Code 
Tel
Fax 
*Email 
 
REGISTRATION FEES:    First Fee:  .
                                      Second Fee:  .
 
Registration fee includes:
  •  Congress bag and Certificate of attendance
  •  Access to scientific sessions
  •  Opening ceremony
  •  Coffee breaks
  •  Lunches
  •  Visit to Exhibits

BANK TRANSFER
Trust and Traders:
Account no. 5254709228-002, Byblos Bank
Ashrafieh, Lebanon - St. Nicolas Street
Swift no. BYBALBBX
                       PS: Fields marked with a (*) are required.

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