Registration Form
PERSONAL INFORMATION
Name
*
First
Last
Hospital or Institute
*
This info will appear on your personal name tag
Email
*
Mobile phone number
*
Dietary wishes (optional)
BIG-number (Dutch participants)
What is your skills level?
Basic
Intermediate
Advanced
What is your background?
Neurologist
Radiologist
Different
Different - Please specify
PARTICIPATION
Promotional code (optional)
Conference participation
Conference participation - € 1.050 ex VAT
Single day - Wednesday September 25 - € 600 ex VAT
Single day - Thursday September 26 - € 600 ex VAT
Single day - Friday September 27 - € 600 ex VAT
Conference dinner
Conference dinner Thursday - € 55 ex VAT
Conference participation - Code
Participation - Wednesday September 25
Participation - Thursday September 26
Participation - Friday September 27
Conference dinner - Thursday September 26
Hotel Fletcher Nieuwegein
Hotel Room - Tuesday September 24 - € 135
Hotel Room - Wednesday September 25 - € 135
Hotel Room - Thursday September 26 - € 135
Hotel Room - Friday September 27 - € 135
Hotel Fletcher Nieuwegein - Code
Hotel Room - Tuesday September 24
Hotel Room - Wednesday September 25
Hotel Room - Thursday September 26
Subtotal
€ 0,00
VAT (21%)
€ 0,00
Total Amount
Conference Participation
Price:
Conference Dinner - Thursday
Price:
Conference Dinner - Thursday
Price:
Single day - Wednesday September 25
Price:
Single day - Thursday September 26
Price:
Single day - Friday September 27
Price:
Single day code - Wednesday September 25
Price:
Single day code - Thursday September 26
Price:
Single day code - Friday September 27
Price:
Hotel Fletcher - Tuesday September 24 (0% VAT)
Price:
Hotel Fletcher - Wednesday September 25 (0% VAT)
Price:
Hotel Fletcher - Thursday September 26 (0% VAT)
Price:
Hotel Fletcher - Friday September 27 (0% VAT)
Price:
Hotel Fletcher code - Tuesday September 24
Price:
Hotel Fletcher code- Wednesday September 25
Price:
Hotel Fletcher code - Thursday September 26
Price:
INVOICE DETAILS
Company or Institute
*
Department / Contact person (optional)
Address
*
Postal Code
*
City
*
Country
Name
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