THE EUROPEAN MEDICINES REGULATORY NETWORK:

PRESENT AND FUTURE

X Foresight Training Course

organised by

Gianni Benzi Pharmacological Research Foundation
/ Master in Regulatory Sciences ‘Gianni Benzi’
University of Pavia

In collaboration with

Istituti Clinici Scientifici Maugeri
/ Società Italiana Attività Regolatorie

27th – 28th October, 2017

Aula Adolfo Bogoncelli, Istituti Clinici Scientifici Maugeri - Pavia (Italy)

REGISTRATION FORM

Please return the form to GIANNI BENZI PHARMACOLOGICAL RESEARCH FOUNDATION

within 20th October 2017, by email: .

Name / Surname
Date and Place of birth
Address
Post code / Town / Country
Tel. / Mobile / Email
Organisation
Job title
Address of Organisation
Post code / Town / Country
Tel. / Fax / Email
Taxpayer number / VAT number
Full Course
Standard fee / EUR 300.00*
Fee before 30th Aug. 2017 / EUR 200.00

*Exempt from VAT as provided by article 10 (D.P.R. 633/1972)

The registration fee includes: access to scientific sessions, congressional kits, additional material, coffee breaks and lunch.

Method of Payment
Bank transfer to: Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus
IBAN code: IT57D0312704000000001001931 – BIC / SWIFT code: BAECIT2B
Date / Signature
PRIVACY
In conformity with the Italian Legislative Decree n. 196, art. 13 of 30 June 2003, the Gianni Benzi Foundation informs you that the collected personal data will be handled for organisational purposes related to this event and will be by no means released to third parties. Moreover, the collected personal data can be handled for sending you free of charges the documentation related to other congresses or initiatives organised by the Gianni Benzi Foundation only. As provided by art. 7 of the Decree n. 196, art. 13 of 30 June 2003, you can contact Gianni Benzi Foundation for further information (crossing out, correction, integration of data). If you agree, please give us your authorisation. I authorise the handling of my personal data for the above mentioned aim(s):
YES, for the X FTC purposes only (mandatory) / YES, I also want to receive information on future courses and events organised by the G. Benzi Foundation
Date / Signature

2