Registration
Name*:
National citizen card/Passport number*:
Email*:
Mobile*:
Address*:
Billing address*:
Hospital*:
VAT number*:
Position (resident, specialist, year of residency/specialist)*:
Comprovation of Bank Transference(bank account number PT50 0045 1210 40235951433 20)*:
Choose a file
Comprovation of EAMS membership (invoice receipt, certificate):
Choose a file
Comments:
* required fields
Submit
NOTE:
after submission a confirmation email will be sent no more than 5 days
