Registration form EFSUMB Level 1 EUROSON
Dermatologic Ultrasound Course
Dermatologic Ultrasound Teaching Centre
Hospital Universitario Puerta de Hierro Majadahonda
Madrid – Spain
(Majadahonda 1st and 2nd june 2018)
Name and surname:  *
Address: Postal code:
Country: City:
Specialty: * Mobile phone:  *
E-mail:  *
Prof. Assoc. number: * Request invoice: Yes No  *
Registration fees:    
Dermatologic Ultrasound Course: 750,00 €  
Resident fee: 500,00 €  
Payment method:
Bank transfer to: Grafismo Autoedición, C. B.
You will receive the bank account data through the confirmation that we will send you by email.
You are informed that the personal data that you send with this form will be subject to computer processing and incorporated into the files of Grafismo Autoedición, C. B., to manage your participation to the course. In addition, your contact details will be used to send you information related to the course.