Individual Registration

Please enter information in the form below to process registration for event 2-Day Event | 27 & 28 March 2026.

Contact details:

Salutation *

Mr.

Mrs.

Dr.

Prof.

First Name *

Last Name *

Position and/or specialty *

Email *

Retype Email *

Mobile Phone Number *

RIZIV | INAMI number | mandatory for Belgian delegates who wish to obtain accreditation -- BIG number mandatory for Dutch delegates who wish to obtain accreditation

Affiliation:

Name of institute *

Department *

Address *

Postal Code *

City *

State

Country *

Correspondence address:

Same as affiliation address above? *

Yes

Address *

Postal Code *

City *

Country *

Membership *

Trainees special

Members of NBVN

General

Payment Information

Amount

€

Payment Method

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

Register

Individual Registration

Contact details:

Affiliation:

Correspondence address:

Payment Information