|
Name/Surname*
|
| |
Henny van der Mei
|
|
Place of birth
|
| |
Netherlands
|
|
Date of birth
|
| |
10/04/1959
|
|
Fiscal Code (Italy or 000000 if foreigner)
|
| |
000
|
|
Email
|
| |
h.c.van.der.mei@umcg.nl
|
| FISCAL DATA |
|
Name/Surname – Company
|
| |
UMCG
|
|
Address
|
| |
Department of Biomaterials & Biomedical Technology FB-40
Groningen 9713 AV
Map It
|
|
VAT n. (only for company or University)
|
| |
000
|
|
Fiscal code (Italy of 000000 if foreigner)
|
| |
000
|
|
Codice Univoco (for Italy)
|
| |
000
|
|
PEC (Italy)
|
| |
000
|
|
Payment
|
| |
Carta di Credito
|
|
Carta di credito
|
| |
MasterCard
XXXXXXXXXXXX6223
|
|
Ordine
|
| |
| Prodotto |
Quantità |
Prezzo unitario |
Prezzo |
|
Registration fee (social dinner not included)
|
1 |
490,00 € |
490,00 € |
|
No
|
1 |
0,00 € |
0,00 € |
| |
Subtotale |
490,00 €
|
| |
Totale |
490,00 € |
|
