Meeting Registration

Submitted by miramadmin on Tue, 08/01/2017 - 13:28

Language English

Name *

e-mail *

Affiliation *

Payment

Payment should be done to the following CGQ IBAN: PT50 0035 0836 0000248 8330 35 or BIC SWIFT: CGDIPTPL with the description: your first & last name + MIRAM 2017 (example: Antonio_Santos_MIRAM2017)

Payment receipt *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png tif pdf.

NIF *

Name *

Address *

Status Confirmation: Student/ Imaging Department Coordinator / Supervisor / Tutor *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png tif pdf doc docx.

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Meeting Registration