REGISTRATION

Participant Data

Mr/Mrs *:
Name *:
Surname *:
Hospital/Institution *:
Department *:
Address of institution *:
City *:
Country *:
e-mail *:
Mobile:

Professional Data:

Speciality:


(Document, confirming residency status must be send to: asco@clinicalmedicine.ge)



BANK ACCOUNT

For Georgian Participants
FOR GEL TRANSFER

BENEFICIARY’S BANK JSC TBC BANK
TBILISI, GEORGIA
SWIFT: TBCBGE22

BEN’S IBAN GE20TB0671636020100002

NAME OF BENEFICIARY ACADEMICIAN FRIDON TODUA MEDICAL CENTRE LTD- 'RESEARCH INSTITUTE OF CLINICAL MEDICINE' LTD
For International Participants
FOR USD TRANSFER

BENEFICIARY’S BANK JSC TBC BANK
TBILISI, GEORGIA
SWIFT: TBCBGE22

BEN’S IBAN GE37TB0671636120100003

NAME OF BENEFICIARY ACADEMICIAN FRIDON TODUA MEDICAL CENTRE LTD- 'RESEARCH INSTITUTE OF CLINICAL MEDICINE' LTD