Application for the TCM Congress Prague, Nov. 25-28, 2010

FIRST/GIVEN NAME *:
LAST/FAMILY NAME *:
TITLE:
ADRESS *:
MOBILE PHONE *:
E-MAIL *:
I WILL PAY BY BANK TRANSFER *:  
WITH GALA EVENING? *: 
 
FEES:  *: 
 
NOTE:
 

BANK ACCOUNT NUMBER:

Tradicni cinska medicina

Komercni banka

U Pruhonu

Prague 7

Czech republic

IBAN CZ3901000000434371310217

SWIFT(BIC) KOMBCZPPXXX