Registration: Liposculture


NAME

STREET

ZIP-CITY

COUNTRY

TEL

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WORKSHOP / PAYMENT :

Dr. M. Mugrabi Lärchenstraße 8-10
30161 Hannover
Tel. :0511-36 37 10
Fax. :032-121073768
Email:
mugrabi@dr-mugrabi.de
dr_mugrabi@yahoo.com
Bank :
Santander
Knt-Nr.: 25 819 15 600
BLZ      : 500 333 00
Signature :..................................................................................
If you are interested to participate in a
Course, please fill out the registration
Form and fax it to us
Speakers, Topics and Schedules can change
if necessary
FIRST COME-FIRST SERVE
LIMITED NUMBER OF
PARTICIPANTS

To guarantee an optimal benefit for each
Participant, the number of participants
is limited