Individual Registration

Please enter information in the form below to process your registration for event ATLS.be course (FR) (UCL).

Ticket Information

Ticket Type	Price	Available place	Quantity
Trainee Fee ATLS (FR) 26-27/06/2023 Trainee-level participation fee	€900,00	9
Consultant Fee ATLS (FR) 26-27/06/2023 Consultant-level participation fee	€1.200,00	0	N/A

First Name *

Last Name *

RIZIV-INAMI *

Hospital/Institution *

Professional Address (Street + nr) *

Professional Address 2

City *

Postal Code *

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Fax

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Comment

VAT Number Hospital/Institution

Training year *

Current Work Department *

Date of Birth *

Home Address - Street *

Home Address - Number *

Home Address - Postcode *

Home Address - City *

Home Address - Country *

I accept that my personal details are shared with the American College of Surgeons and the Royal Belgian Society for Surgery in view of my participation in the proposed ATLS course as well as in the follow-up of the training. *

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. *

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Payment Information

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€

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Offline Payment

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