APPLICATION FORM

Please pick me up in Latvian Society of Phlebology. I provide the following information:

Name:
Surname:
Personal code:
Address:
Phone:
Fax:
E-mail:
Comments:

 

If you have problems with the transmission of the questionnaire, please print and fill out a form, that can be send by mail. Our address - Latvian Society of Phlebology, Pilsonu str. 13, Riga LV-1002, e-mail: flebologs@inbox.lv