ACTOS 2024 - REGISTRATION FORM
Step 1 - Conference Participation
Distributor name
*
Please select
ASAHI Intecc
Brage
Cardirad
Euromedical
Kardia
Novomed
Premier G
ProCardia
RSR
Sidroc
TOP Medical
Vascular Medical
Vascular Perspectives
World Medica
Your e-mail address for a confirmation of registration
*
Conference participation
*
Participation Thursday - November 28
Conference dinner - November 28
Participation Friday - November 29
Hotel accommodation - Single room
Wednesday November 27 - Single Room
Thursday November 28 - Single Room
Friday November 29 - Single Room
Hotel accommodation - Double room
Wednesday November 27 - Double Room
Thursday November 28 - Double Room
Friday November 29 - Double Room
Step 2 - Personal Information
First name
*
Last Name
*
Hospital or Institute
*
City
*
Country
*
Email
*
Dietary wishes (optional)
BIG-number (Dutch participants)
Thursday
Dinner
Friday
Single Wed
Single Thu
Single Fri
Double Wed
Double Thu
Double Fri
Phone
This field is for validation purposes and should be left unchanged.
