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Eurasia Registration

Please enter all with * marked fields (fields required).

Name*

Surname*

Street*

Postal Code*

City

Country*

Telefon*

Fax

E-Mail*

How would you like to pay?

Credit card (we will send you a special form, that you have to fill and fax back)

How would you like to receive the registration confirmation?

Main conference (early birds 650 Euro, after 1.11.09 775 Euro)
book (required)

Number of optional workshops (maximum of 5)

Workshop cardiology (50 Euro)
yes
no

Workshop feline internal medicine cases (50 Euro)
yes
no

Workshop canine internal medicine cases (50 Euro)
yes
no

Workshop endocrinology (50 Euro)
yes
no

Workshop neurology(50 Euro)
yes
no

Comments
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