BSP Membership Application Form
Thank you for starting your Belgian Society of Pathology membership.

Trainees have to send a certificate to the secretary, signed by their mentor
Payment should be received on Belgian Society of Pathology (BSP) account: BE35 7320 2896 2837 - put as reference: Membership 2018 - Your name + Email
Should you have any queries regarding Belgian Society of Pathology membership, please contact us info@belgian-society-pathology.eu

Looking forward to meeting you soon.

Membership
Year of Membership *
Required
Membership *
Personal Details
Title *
First name *
Your answer
Last Name *
Your answer
E-mail *
Your answer
Hospital, Institution, Lab *
Your answer
Specialty *
Your answer
INAMI - RIZIV number : (Put NA for non available) *
Your answer
Working Groups
I want to be active in the following working groups
Invoicing Details
Fill in if you need an invoice. Make sure you have the VAT number.
Type of Address
Billing Name
Your answer
Address line
Your answer
Additional address line:
Your answer
Zip Code
Your answer
City
Your answer
VAT
N/A if not applicable
Your answer
Email Permission
By providing my contact details below, I authorize the Belgian Society of Pathology to send me communications that may include education information & promotional materials considered to be official BSP correspondence to its members. Note: BSP does not release, sell or grant permission for the use of membership e-mail information to any outside the organization. This contact information is solely for the use of the Belgian Society of Pathology
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