Registration Renewal Form years 2018      


Personal Details
il
Registration fee
2018 - € 50   2017 - € 50   2016 - € 50  
Payment methods
to:
Number: - - -
Type: Visa Master Card
Security Code: (OBLIGATORY)
Expired -


Date The applicant
25 - 05 - 2018 ______________________________
Send To:
Nicola Capozza, Tesoriere SIUP U.O.C. di Chirurgia del Trapianto di Rene e Pat. Correlate - Ospedale Pediatrico "Bambino Gesù" Piazza S. Onofrio, 4 - 00165 Roma E-mail: capozza@opbg.net
Tel: +39.06/68592430 Fax: +39.06/68594531