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Online Registration Form (Krakow 2024)
*Complete this form to register your interest in the International Neuromodulation Congress in Krakow, Poland on 17 October 2024. For further information, contact:
ciaranwazir@gmail.com
or visit
www.painandneuromodulationpoland.com
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Title:
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Dr
Prof
Mr
Mrs
Miss
Forename:
*
Your answer
Surname:
*
Your answer
Medical Speciality (anaesthesia, neurology, etc):
Your answer
Clinic/Hospital/Company address:
*
Your answer
Postal Address:
*
Your answer
E-mail Address:
*
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Mobile Phone Number:
*
Your answer
Please let us know whether you would like to attend the International Neuromodulation Congress in Krakow on 17.10.24:
*
yes
No
undecided
Required
Please let us know whether you would like to submit an abstract for the free oral and poster presentations at the congress on 17.10.24:
*
yes
No
undecided
Required
Please also let us know whether you would be interested in attending the 14th Hands-on Cadaver Workshop on Interventional Pain Medicine & Neuromodulation Procedures in Warsaw on 19.10.24:
*
yes
No
undecided
Required
Preferred Registration Payment Method:
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Debit/Credit Card Payment (Euros)
Bank Transfer (Euros)
Bank transfer (PLN)
Dietary Requirements for the Meeting Catering:
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Comments for the organisers:
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