* Last Name
* First Name
* Documentation Passport
* Passport Number
* Nationality
* Society to which it belongs
* City
* Province
* Country
* Telephone
* Cell phone
* Email
* Performance Institution
* Participate in the event as: —Por favor, elegí una opción—Resident USD 250AR/BR/PY Doctor USD 350FILACP Member USD 450Non Member USD 500
* Payment method: Stripe USDPrisma AR$
* Attach certificate by Head of Service