III ESUBE MASTERCLASS - REGISTRATION FORM - Planify Events - Organizzazione Eventi e strategia di comunicazione

First Name

Last Name / Surname

Date of Birth

Country of Birth

Residential Address

Street Address

City / Town

Postal / Zip Code

MEMBER the or

Country

State

Fiscal Code or VAT Number

Email Address

Phone Number / Mobile

Affiliated Institute

Specialty and Subspecialty

Endoscopic Surgery Level

Estimated Number of Procedures per Year

ESUBE Member

Yes
No

Registration Package

3-Day Pass (22-24 April 2027) – Early Bird Ticket – € 1.890 from January 1st, 2027 € 2.100
2-Day Pass (22-23 April 2027) – Early Bird Ticket – € 1.440 from January 1st, 2027 € 1.600
2-Day Pass (23-24 April 2027) – Early Bird Ticket – € 1.440 from January 1st, 2027 € 1.600

Registration Package ESUBE Member

3-Day Pass (22-24 April 2027) – ESUBE Member – € 1.890
2-Day Pass (22-23 April 2027) – ESUBE Member – € 1.440
2-Day Pass (23-24 April 2027) – ESUBE Member – € 1.440

Food Intolerances

Terms and Conditions

I Agree
I Refuse

I wish to receive promotional newsletters and updates from Planify Events

I Agree
I Refuse

Choose payment method

Credit Card
Paypal
Transfer Bank

3-Day Pass (22-24 April 2027) – Early Bird Ticket – € 1.890

2-Day Pass (22-23 April 2027) – Early Bird Ticket – € 1.440

2-Day Pass (23-24 April 2027) – Early Bird Ticket – € 1.440

PayPal or Credit Card

Number

Expiration Date

Secure Code

Card Holder Name

3-Day Pass (22-24 April 2027) – ESUBE MEMBER – € 1.890

2-Day Pass (22-23 April 2027) – ESUBE Member – € 1.440

2-Day Pass (23-24 April 2027) – ESUBE Member – € 1.440

BANK ACCOUNT DETAILS

Account holder: Planify Srl

Bank name: Intesa San Paolo – Filiale Napoli Riviera di Chiaia

IBAN: IT57D0306903523100000072433

BIC / SWIFT code: BCITITMM

Reference / Payment reference: YOUR NAME – III ESUBE MASTERCLASS

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