Registration Form
Phone
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Personal Information
First name
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Last name
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Hospital or Institute
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City
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Country
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E-mail address
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Mobile phone number
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Dietary wishes (optional)
BIG-number (Dutch participants)
Participation
Promotional code (optional)
Conference participation
Early bird participation - € 195 (including 21% VAT)
Participation Faculty
Thursday Participation - September 24
Thursday Faculty Dinner - September 24
Friday Participation - September 25
Hotel Accommodation - Faculty
Single Room - Wednesday September 23
Single Room - Thursday September 24
Double Room - Wednesday September 23
Double Room - Thursday September 24
Subtotal
€ 0,00
VAT (21%)
€ 0,00
Total Amount
Early bird participation
Price:
Thursday
Price:
Dinner
Price:
Friday
Price:
Wednesday Single - Code
Price:
Wednesday Double - Code
Price:
Thursday Single - Code
Price:
Thursday Double - Code
Price:
Invoice Details
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Address
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City
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