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INDIVIDUAL REGISTRATION FORM
In order to be informed about PSE conference news, please fill in correctly the contact information bellow.

Attention! All the form fields are mandatory.

FIRST NAME
LAST NAME
Type of participant (e.g physician, pharmacist, biologist, chemist etc)

I WILL ATTEND THE MEETING AS:



SERVICES
Conference registration *
Registration fee

PERSONAL CONTACT INFORMATION
City
E-mail
Phone
OTHER INFORMATION
Institution
Department
Address
City
Country
CNP or CUIM for romanian pharmacist or physician
Specialization
LOGIN DATA
Username
Password
Confirm password
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