. Name *Surname *Email *Profession *Institute *Zipcode and city *Phonenumber *Number of RIZIV / INAMIBIG/NVKC numberAre you a NVC memberYesNoI want to be a member Registration Day 1 11 March (reduced fare) (€ 135,00) Registration Day 2 12 March (reduced fare) (€ 67,50) Registration both Days 11-12 March (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
