Berrly - MIFAS by Grecmip

Name * Trade name *

Last name*

Gender

Birthdate*

Phone

Phone (Mobile)*

E-mail 1 *

E-mail 2

Address*

Zip code*

City*

Province

Region

Country*

Social networks

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Payment details

Payment method*

Account holder*

Bank IBAN*

Bank BIC

PayPal

Professional details

Institution (FAS)

Address (FAS)

ZIP Code (FAS)

City (FAS)

Country (FAS)

Phone Number (FAS)

Email (FAS)

Website (FAS)

Surgical Specialty (FAS)

Curriculum Vitae (FAS)

Max: 8MB

Other Details

Do you have experience in MIS Surgery?

Have you attended a MIFAS by Grecmip Course?

Do you agree to have your (FAS) details appear in the Find a Surgeon area of the website?

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In accordance with the provisions of the General Regulation of Data Protection of the European Union, we inform you that the data introduced in this form will be treated exclusively for registration purposes and communications regarding educational activity within the society and is property solely of MIFAS by GRECMIP and will not be shared with other organizations. At any time you can exercise the rights of access, rectification, opposition, limitation, and, where appropriate, portability or cancellation by sending an email to contact@mifas.org

By becoming an active member of MIFAS by GRECMIP I acknowledge the obligation to pay annually the fee of 90,00€ in order to benefit from the advantages to which members are entitled. The status "Active Member" will lapse at the end of each year and in order to remain an active member, the Annual Membership fee will have to be paid again at the beginning of the next year.

Pre-registration

Social networks

Payment details

Professional details

Other Details

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