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Academic title

Select academic title

First name

Family name

E-mail address

The same email address cannot be used for multiple registrations.

Phone number

Medical degree

Primary care physician, specialist, resident, student, etc...

Medical specialty

CUIM

The Unique Registration Code of the Doctor at the Romanian College of Physicians. Only for doctors practicing in Romania

Work place

City

Country

Company name

Name on which the invoice will be issued: the name of the company or the name on which the tax invoice will be issued.

Customer type

Select if you want the invoice for the individual or the company.

Fiscal Identification Code

CUI/CIF on which the invoice will be issued.

Entity address

Address on which the invoice will be issued.

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The First Vertigo Congress
in Romania

Registration form
The First Vertigo Congress in Romania