Please complete and return form, together with your payment to:
7th World Congress on Heart Failure
PO Box 17659, Beverly Hills, CA 90209, USA
Tel: +1 310 657 8777
Fax: + 1 310 275 8922
Click here to download a Word file with this form.
Please complete this section accurately; the information you provide will
allow us to correspond with you efficiently, and will also be used on your
delegate badge at the Congress.
Field marked in red are required.