I register for PhD Course *YesNo
I register for Symposium *Symposium day 1Symposium day 2Full SymposiumNo
First name *
Prefix
Last name *
Institution *
Department *
E-mail *
Phone
Address *
Postal code *
City *
Country *
Gender *
Basic/Clinical researcher *
Are you an NVTH member? *YesNo
NVTH member # (if known)
BIG registration #
For PhD students: I prefer to share a hotel room with *
Dietary requirements
Optional remarks
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Bedrag * €
I hereby register to and accept the terms and conditions as described below *
Payment method *
Complete registration