Advanced Breast Cancer - OECI

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REGISTRATION FORM ABC2 – 7-9 November 2013, Lisbon, Portugal Please fill in this form in block capitals and send by the deadline to: European School of Oncology, ESO Bellinzona Office, Attn. Laura Richetti Piazza Indipendenza 2 – 6500 Bellinzona, Switzerland – Fax +41 91 820 0953 – lrichetti@eso.net Online registration is available at www.abc-lisbon.org Participant’s details Dr. Prof. Surname Institute Name Department Street Zip code Town Country Phone Fax Mobile e-mail Profession Specialisation Main field VAT number (compulsory for self-employed persons) Fiscal code (Italian residents only) If your invoice details are different to those above, please complete the following section: Invoice contact person Address Phone e-mail VAT number (compulsory for companies or self-employed persons) Fiscal code (Italian residents only) Payable in Euro Early (by 19 August 2013) Late (by 21 October 2013) Registration fee EUR 400 Club ESO Members ESMO Members EUR 300 EUR 500 Payment details The registration is processed when payment accompanies the form (credit card details or copy of bank transfer) Visa/Mastercard Number Expiry date CV2 code Holder’s name: and signature Bank transfer with no cost to the beneficiary (please provide a copy of the bank transfer): Bank Banca Popolare di Milano, Agenzia 24, Milano, Italy Holder European School of Oncology Number 16333 IBAN IT96G0558401624 0000000 16333 BIC BPMIITM1024 Reference «ABC2 + your name» I authorise the European School of Oncology to use my personal data according to what is specified in Article 13 DLGS 196, available at www.eso.net or on request at fax number +39 02 8546 4545. Signature Date
It’s easy to save money on your flights if you fly the Star Alliance network. Simply quote the event code TP01S13 when you make your booking with any Star Alliance member airline and you’ll automatically get a discount of up to 20%. The Star Alliance network has 27 member airlines with over 21,555 flights a day so we can offer you a lot more choice when planning your travel. For more information about our member airlines and contact details, please visit our website at staralliance.com/conventionsplus staralliance.com Information correct as at 06/2012
Page 1 and 2: September-October 2012 Number 50 IT
Page 3 and 4: Dates and Team By 8 July 2013 Abstr
Page 5 and 6: General information Venue ABC2 will
Page 7 and 8: Kimberley L. Blackwell Breast Cance
Page 9 and 10: Coordinators: Fatima Cardoso Breast
Page 11 and 12: Preliminary programme outline Wedne
Page 13 and 14: 10:45 Inoperable locally advanced b
Page 15 and 16: Abstract submission Deadline for su
Page 17 and 18: Group registration The online group
Page 19 and 20: Hotel accommodation Deadline for bo
Page 21 and 22: Optional tours Viagens Abreu offers
Page 23 and 24: Half day tour to Óbidos and Fátim
Page 25: Notes .............................

Advanced Breast Cancer - OECI

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