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Registration Form

To register with the workshop please complete the form below and then make a payment.
Payments done without completing the form leave us unable to contact you.

Title

First Name

Family Name

Email

City

Address:

Country

Company

Tax number

I would like to practice the following procedures:


Now please return to the Book a Place page for payment details (bottom of the page).

© 2012 Fundacja Promocji Medycyny Bólu - Foundation for the Promotion of Pain Medicine - kontakt@medycynabolu.com.pl; mobile: +48 509 701 803

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