Name: ICTHIC 2022, Bergamo Italy
Start: 2022-05-27T00:00:00+01:00
End: 2022-05-29T23:59:59+01:00
Location: Hotel Mercure Bergamo

Title*

First Name*

Last Name*

Email*

Daytime Phone Number*

Mobile Number*

Job Title*

Company/Hospital Institution*

If you are an EADV member please enter your membership number here:

Please provide details of any dietary requirements i.e. nut allergies, gluten free, Kosher, vegetarian, dairy free etc.

Please provide the following details from your passport

Full Passport Name*

Nationality*

Gender on passport*

Birth Date*

Passport Number*

Passport Issue Date*

Passport Expiry Date*

Preferred Departure Airport*

Full Postal Address*

Emergency Contact Information: name, contact telephone number, relationship*

Additional requirements, e.g. special travel requests, departure train station, Eurostar:

ICTHIC 2022, Bergamo Italy

27 May 2022 - 29 May 2022