Registration Form

The 1st International Medical Physics Workshop in Lebanon on Diagnostic Imaging and Radiotherapy

December 1-4, 2018 / Hilton Beirut Metropolitan PalaceSin El Fi -Lebanon
REGISTRATION FORM
FULL NAME*

PrefixFirst NameLast Name
HOSPITAL/ORGANISATION*

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CityState / Province

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JOB TITLE AND POSITION*

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CityState / Province

Postal / Zip Code
COUNTRY*

Street Address

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CityState / Province

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GENDER*

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EMAIL*
example@example.com
TELEPHONE NUMBER*

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CATEGORY*

Physician { US$ 250}Medical Physicist { US$ 200}Biomedical Engineer {US$ 200}Technologist {US$ 150}Student {US$ 100}
PAYMENT METHOD*

Prepay (Contact leb.workshop2018@gmail.com for arrangement)Pay on Arrival
For Program and Conference Information:https://www.mefomp.com
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REGISTRATION FORM