Registration form

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Personal data

First name:*

Last name:*

CNP:*

Specialization:*

Speciality:*

Type of the US machine used:*

Title:

Professor Doctor

Contact address

Hospital/Institution:*

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Area of interest for the next course:*

Need a hotel room ?:*

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Would you like to participate (free of charge) at the ceremony of granting the "Doctor Honoris Causa" title to the Prof. dr. Luigi Frati (Rector of "La Sapienza" University of Rome) on 11 April 2010, 19,00 hours at Romanian Atheneum ( will perform "Ermil Nichifor" Doctor's Orchestra )?: * Yes No

Fee payment information

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Ordin de plata Paypal

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Registration fee

Participants to the “UCD International CEUS course” will have to pay a registration fee of 150 € or 600 lei that includes :

Admission to all course sessions and hands on,
Possibility of CME credits gain,
Course bag,
Syllabus,
DVD material,
Coffee breaks, lunch and social dinner.

Registration fee for companions
• Full time companion : 80 € or 320 lei (participate at all coffee breaks, lunch and social dinner)
• Social dinner companion : 35 € or 140 lei (participate only at social dinner)

Payment details :

Ultrasound Media srl
RO 26534100
J40/1695/2010
Bucuresti, str. Rovine, nr.2,sect.2
Bank : Bancpost Mosilor
Account : RO23 BPOS 7020 7040 616R ON02

Note : Please send the completed registration form to office@ultrasoundmedia.ro no later than 1^st of April 2010.

Please, be aware that the course will have a limited number of participants!