Registration with abstract or you are a trial coordinator/ study nurse

We are sorry! This form is no longer active. Please don't use the form below. If you want to be placed on the waiting list please email us at secretariaat@bureau-prevents.nl. We can then add your name to our waiting list.

For participants who have also submitted an abstract (to maaike@bureau-prevents.nl) to be discussed during the conference,
or you are a trial coordinator/study nurse a reduced rate of 185 euros applies. If not, click here.

Participation is only possible for the two days.
Hotel stay must be arranged by participants.

We aim to meet you all in person. However, in view of the then current global situation, we will adapt the meeting in accordance with adjustments in design relevant in November 2026.

• Before registering, please check our cancellation policy
• Representatives from industry are NOT eligible to register as participants. Sponsorship opportunities are available.
  For more information, please contact: maaike@bureau-prevents.nl

Gender:		Mrs.     Mr.     Gender neutral
Title:
First name:
Prefix:
Surname:
Country:
Phone number (+country code):
E-mail address:
Specialism:
You are:		physician fellow in training
Hospital:
City:
Country:
BIG code:
Payment method:		Electronic banking (iDeal, MasterCard, Visa, American Express, Pay Pal and more)   (this is the only payment method)
		Debit (SEPA, Single Euro Payments Area)
Ascription:  Address:  Postal code:  City:  Country:  IBAN number:    You can enter your IBAN number above. BIC code:        Select a bank for your BIC code. If unavailable you need to bring your complete BIC code.
		Invoice address (optional) We kindly ask you to ensure that the billing address is entered correctly. Unfortunately, any changes will be charged.
Name:
Address:
Zip code/City:
Country:
VAT number:
Permission required due to General Data Protection Regulation (GDPR) Agree that we process your data in accordance with our Privacy Statement and Sponsor Policy. It is mandatory to fill in this box: otherwise we will unfortunately not be able to register you.
Question (optional):
(Fields that are marked with a   are mandatory fields)