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REGISTRATION

 Please use this form only to register at a Course in Graz. For all other Courses announced at this website, please contact the local organiser.


Registration
Title *
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First Name *
Profession *
Affiliation 1 *
Affiliation 2 *
Street *
Postal code *
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Email *
Telephone *
Fax
Course *
  METHOD OF PAYMENT
Bank transfer to:
  "Dr. Einspieler - GM Trust"
Austrian PSK, A 1018 Vienna
Bank Code: 60.000
Bank Account: 78.519.114
BIC: OPSKATWW
IBAN: AT176000000078519114
Credit card Euro/Mastercard Diners VISA
Card Number
Expiry Date
Name on Card
Signature
  If you prefer to pay by Credit Card, don´t submit the Registration form.
Print out the form by using the "print symbol" in the menu and send or fax it to:

Dr. Christa Einspieler
Dept. Systems Physiology, Medical University Graz
Harrachgasse 21
A - 8010 Graz, Austria, Europe
Fax: +43 316 380 69 9630
 
Copyright
© Copyright by Dr. Christa Einspieler, 2009
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