DEBS 2026

Professional title

First name

Last name

Gender

Medical Association of [city]

Medical license number

Date of birth

Place of birth

Country of birth

Please provide a valid ID document. If you are not Italian, a passport is required.

Contact details

Email address

Phone prefix

Phone number

Address

City

Country

Postal code

Province (for Italian participants only)

Fiscal Code (for Italian participants only)

About your institute

Name of hospital/institution where you work

City of your institution

Country of your institution

Region

Invitation Letter (for hospitals/institutions in Italy only)

Do you need an official invitation letter?

Yes No

Richiedo lettera di invito nominativa a me indirizzata.

La lettera sarà inviata solo a Lei e non al Suo Ente di appartenenza.
Trattandosi di una candidatura individuale non sponsorizzata, non sono previste comunicazioni a terzi.

Se necessario sarà suo dovere inoltrarla all’ufficio formazione di competenza.

Should you need an official invitation for VISA

Yes No

Passport number

Full name

Issued by country

Expiration date

Profession (hold Ctrl or Cmd to make multiple choises)

Your specialty

In order to secure your grant, please provide your credit card or debit card details a guarantee of your attendance
In case of cancellation within 7 days before the congress starts, the amount of €244.00 (corresponding to 50% of the registration fee) will be charged on you.

Credit card

Information concerning the protection of personal data in observance of the EU GDPR law 2016/679