Individual Registration

Please enter information in the form below to process your registration for event 16th Thoracic Meeting Mons.

First Name *

Last Name *

RIZIV-INAMI *

Hospital/Institution *

Professional Address (Street + nr) *

Professional Address 2

City *

Postal Code *

Country *

Phone *

Fax

Email *

Comment

VAT Number Hospital/Institution

I accept that my personal details are stored and/or used by the course organisers to keep me updated about future educational activities or other information on surgical training. *