. Name *Surname *Email *ProfessionInstituteZipcode and cityPhonenumber *Number of RIZIV / INAMIBIG/NVKC numberAre you a NVC memberYesNoI want to be a member Registration Day 1 25 November (reduced fare) (€ 135,00) Registration Day 2 26 November (reduced fare) (€ 67,50) Registration both Days 25-26 November (reduced fare) (€ 202,50) Bedrag * € Betaalmethode * iDEAL Bancontact Belfius Pay Button (+ 1%) Hierbij geef ik toestemming om het terugkerende bedrag periodiek van mijn rekening te incasseren. Totaal € Send form
