Fundació URV   REGISTRATION FORM - Maritime Health: Conditions of Work and Prevention


  If you have any trouble or question when filling the form, please contact Natalia Rull: e-mail: natalia.rull@fundacio.urv.cat phone: +34 977 32 74 16

Personal data
Name
 * Surname
 *
Institution
 Id Card / Passport number
*
Address
 * ZIP Code
 *
City
 * e-mail
 *
Country
 *
Phone
  *


Payment options
Amount 600   €
Payment method Visa:
 Credit Card Number :
 Expiry Date:             : 
Bank transfer: Please proceed to do the transfer just need these data:
IBAN ES91 2013 0291 91 0200885225
Swift code CESCES BBXXX
Caixa de Catalunya, Ramon y Cajal 40, 43001 Tarragona
Do not forget to include your name and the code ESAMS as the transfer concept. Please send a fax with the transfer receipt to the course secretariat: +34 977 31 01 13.
[Transfers from Spain just need this data: 2013 0291 91 0200885225 de Caixa de Catalunya]
In compliance with Spanish laws of personal data protection the data in this form will be stored in a confidential file property of FURV. Your data will not be used for any other purpose than the organization of the course. You have the right to access, modify and cancell the stored data, just asking for it by fax or e-mail.
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