Individual Registration

Please enter information in the form below to process your registration for event BSHBPS 24th Post-Graduate Course.

Ticket Type	Price	Available place
RBSS NON MEMBER : Trainee 20€ for participation + 35€ for lunch	€55,00	Unlimited
RBSS NON MEMBER : Surgeon 50€ for participation + 35€ for lunch	€85,00	Unlimited
RBSS MEMBER :Trainee or Surgeon Free for RBSS members, 35€ for lunch	€35,00	Unlimited
No lunch Only tick this box if you do NOT want to have lunch	€-35,00	Unlimited

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

Amount

€

Payment Method

Offline Payment