Individual Registration

Please enter information in the form below to process your registration for event BSCRS - Belgian Night 2025.

Ticket Type	Price	Available place	Quantity
Surgeon	€30,00	Unlimited
Trainee	€0,00	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

Dietary requirements

Amount

€

Payment Method

Offline Payment