Registration

We are sorry! This congress is fully booked. 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.

Registration is accepted according to the 'first come, first served' principle. Participation is only possible for the entire week.

For endocrinologists € 1375 and fellows in training € 1125. This includes hotel room and diner.
For those who do not want to stay overnight registration fees are € 850 and € 650 for endocrinologists and fellows in training, respectively.
The registration fee for online participation is € 450.

Gender:		Mrs.     Mr.
Title:
Name/Initials:
Prefix:
Surname:
Country:
Phone number (+country code):
E-mail address:
Specialism:
You are:		endocrinologist fellow in training
Hospital:
City:
Country:
BIG code:
Accommodation needed?		including hotel stay exclusive hotel stay online participation
Payment method:		Electronic banking (iDeal, MasterCard, Visa and more)
(only electronic banking)		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.
Toestemming nodig i.v.m. Algemene verordening gegevens­bescherming (AVG) Akkoord dat wij uw gegevens verwerken conform ons Privacy Statement en Sponsorbeleid. Dit vakje verplicht invullen: anders kunnen wij u helaas niet registeren.
Question (optional):
(Fields that are marked with a   are mandatory fields)