Registration

* = mandatory fields.

1. Personnal data

First name*:

Last name*:

Email address*:

Email address confirmation*:

Institution/Organization*:

Phone number:

Address*:

Country*:

Do you require accreditation? Please complete the fields below:

For Belgian participants – INAMI/RIZIV number:

For Dutch participants – KVK number:

Other countries – your registration number with your national authority:

Do you require EACCME accreditation?

Yes

I am registering for*:

Full Congress – September 17 to 19
Price: €620
Including Welcome Cocktail (6:00–9:00 PM)
Excluding gala dinner

Full Congress STUDENT – September 17 to 19
Student price: €420
Including Welcome Cocktail (6:00–9:00 PM)
Excluding gala dinner

One-day – September 17
Price: €390
Including Welcome Cocktail (6:00–9:00 PM)

One-day – September 18
Price: €390
Excluding gala dinner

Welcome cocktail – September 17

I will attend the welcome cocktail.

Gala Dinner – September 18

Gala Dinner (+€80)

Accompanying person (+€80)

Special Dietary Requirements:

Select a payment method*:

Bank transfer (QR code available)

Bancontact

Credit card

I would like to receive a receipt

I accept the Terms and Conditions that I can read here.