Registration Form
Personal Information
First name
*
Last Name
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Institute
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Function
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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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BIG Number
Optional for Dutch participants
Dietary wishes
Optional
Participation
Promotional Code
Participation - Code
*
Conference day 1 - Thursday September 18
Conference day 2 - Friday September 19
Hotel Accommodation - Code
*
Single Room - Wednesday September 17
Single Room - Thursday September 18
Early Bird Rates
*
Medical Specialist - € 425 ex VAT
Student / Researcher / Technologist - € 325 ex VAT
Thursday - Conference dinner - € 50 ex VAT
Early Bird Rates - Discount 10%
*
Medical Specialist - € 382,50 ex VAT
Student / Researcher / Technologist - € 292,50 ex VAT
Thursday - Conference dinner - € 50 ex VAT
Subtotal
€ 0,00
VAT
€ 0,00
Total amount
Medical Specialist - Early Bird
Price:
Student / researcher / Technologist - Early Bird
Price:
Medical Specialist - Early Bird (discount)
Price:
Student / researcher / Technologist - Early Bird (discount)
Price:
Thursday - Conference dinner
Price:
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Invoice Details
Institute or Company
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Contact person (optional)
Address
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Postal Code & City
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Country
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Email
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