HELLENIC SOCIETY OF INTRAOCULAR IMPLANT AND REFRACTIVE SURGERY

<%@LANGUAGE="VBSCRIPT" CODEPAGE="1253"%> HELLENIC SOCIETY OF INTRAOCULAR IMPLANT AND REFRACTIVE SURGERY

First Name

Last Name :

Title :

Institution :

Address :

City

Zip

Country

Tel

Fax

ACCOMPANYING PERSON (S)

1. First name:			Last name :
2. First name:			Last name :

*The HSIOIRS members should have paid their annual contribution (50.00€).

PAYMENT METHOD

1. Deposit in bank
2. Postal order payable

1. ALPHA BANK, GLYFADA BRANCH
ACCOUNT Νο.122 00 2320003246 ( HSIOIRS )

2. Hellenic Society of Intraocular Implant and Refractive Surgery, Poseidonos 42, 17561, Palaio Faliro, Attiki

requirement ()