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Please, complete this form to confirm your participation

    Full name (AS IT APPEARS IN THE PASSPORT)

    E-mail

    Phone

    Passport number

    Date of birth

    City

    Date of departure from your city

    Date of departure from Termas de Rio Hondo

    Small Biosketch


    As a conference speaker, I hereby consent to the conference recordingAs a conference speaker, I do NOT hereby consent to the conference recording

     

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