Individual Registration

Please enter information in the form below to process your registration for event BSCRS 22nd Post-Graduate Course.

Ticket Type	Price	Available place
Trainee participation Free for the course, 35€ for lunch	€35,00	Unlimited
Surgeon participation Free for RBSS members (please log in to obtain your reduction) , 35€ for lunch	€65,00	Unlimited
Hands-On Session 50€ for all - only for the Hands On Session, please select the correct ticket above for the post-graduate course	€50,00	14
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