Kindly fill out the following form with your basic data in order to proceed with your registration for the ESCR Educational Workshop - Module 1: CT primer for radiologists.
Workshop RegistrationModule 1 CT
Regular Late: EUR 490.00
Resident Late: EUR 390.00
Kindly note, in order to register for the ESCR Educational Workshops you need to be an active ESCR Member in good standing for the current calendar year.
Early registration: until March 31, 2014Late registration: from April 1, 2014 onwards
Please indicate your preffered payment method.
Credit Card PaymentI herewith authorise the ESCR Office to charge my credit card with the above indicated Workshop registration fee.
Credit card number
Credit card holder's name
Bank transfer payment
In case you prefer to balance the full registration fee as indicated above via bank transfer, please find the necessary details below:
Account holder: ESCR European Society of Cardiac RadiologyBank name: Die Erste BankIBAN: AT182011100005152577BIC/SWIFT: GIBAATWWXXX
Please indicate your full name as well as "ESCR Workshop - CT" on transfer documents. Kindly note that you are responsible for any bank charges that might apply.
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ESCR Educational Workshop - Module 1: CT primer for email@example.com
ESCR Educational Workshop - Module 1: CT primer for radiologistsESCR Educational Workshop - Module 1: CT primer for radiologists0.00
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