MESOTHELIOMA Course - Registration form
Dear Participant,

We thank you for enrolling on the course on “MESOTHELIOMA “on Saturday 16 February 2019.

The registrations are open till 11 February.

Looking forward to welcoming you.

info@belgian-society-pathology.eu
www.belgian-society-pathology.eu

Registration
I will join the symposium *
Participant information
Title
First Name *
Your answer
Last Name *
Your answer
Hospital - Lab - Company
Your answer
Function *
E-mail *
Detailed information, confirmation & invoice will be e-mailed to you
Your answer
INAMI - RIZIV number *
Put NA for non available
Your answer
Comments
Your answer
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