Edizioni minerva medica order form for individual subscription
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| EDIZIONI MINERVA MEDICA
ORDER FORM FOR INDIVIDUAL SUBSCRIPTION Please download the order form, complete it and forward it with the attachments requested to the following email address: subscriptions.dept@minervamedica.it I wish to subscribe to the journal _____________________________________ Year ________ New Subscription Subscription Renewal Subscriber code no. ____________ Print + online Amount € ______________ Payment procedure I paid on ______________ to EDIZIONI MINERVA MEDICA – C.so Bramante 83-85 – 10126 Torino, by: Bank transfer (copy attached) Bank details: INTESA SANPAOLO Ag. 18 Torino, C.so Bramante 82, 10126 Torino – IBAN: IT45 K030 6909 2191 0000 0002 917 – BIC BCITITMM Personal details (all fields are compulsory) First Name __________ Surname __________ Address ______________________________ Post Code _____City __________ Province __ Country ______Telephone ________________ Fax __________ Email___________________ Shipping Details (all fields are compulsory) First Name __________Surname __________ Address ______________________________ Post Code _____City __________Province Country _______Telephone ______________ Fax _________ Email___________________ I wish to receive a receipted invoice. Yes No Personal details will be used for invoicing The details transmitted which you, in accordance with Decree Law no.196/2003 authorise us to handle, will be used solely for commercial purposes and to promote our activities. Updates or cancellation of details should be requested from: Edizioni Minerva Medica, Corso Bramante 83-85, 10126 - Torino. |