Inscription Form
Please answer all the questions. You will complete your mail and e-mail address so that we can send your final confirmation and other important correspondence regarding your registration
Name / Nom / Naam *
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Surname / Prénom / Voornaam *
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Street + Nr / Rue + numéro / Straat + Nr *
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ZIP / Code postal / Postcode *
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City / Ville / Stad *
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Country / Pays / Land *
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Email *
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Phone / Téléphone / Telefoon *
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Hospital / Hôpital / Ziekenhuis *
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Department *
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n° INAMI / RIZIV Nr (if accreditation is requested)
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Billing adress (if different) / Adresse de facturation (si différente) / Factuuradres (indien afwijkend)
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Annual symposium Registration Fees before 31/12/2017
Category *
J'effectue un virement sur le compte de la BESEDIM BE60 6451 1370 6970 avec la communication Symposium 2017 + Nom + Prénom / Ik maak een overschrijving op de rekening BE60 6451 1370 6970 van de BESEDIM met communicatie: Symposium 2017+ naam + voornaam
Attention, Registration Fees paid after 31/12/2017 24h00 will be higher !
Registration fee includes entrance to the full scientific program, hands-on sessions, abstract book and refreshment breaks.
The preferential rate applies to the date payment is received! The organizing committee will reserve the right to control the category status. Submission of the registration form is not valid unless the organizing committee receives the full preferential rate.
(*) By proceeding with payment, you are agreeing with the stated price. No claim for a change in price will be accepted after payment.
Cancellations made before January 6, 2018 will be subject to a handling fee of 25 €. There will be no refunds after this date.
Registration fees for payment after 31/12/2017 24h00:
Physician, member of the BESEDIM (cotisation 2017 paid before 31/12/2017): 150 euros
Physician, non member of the BESEDIM: 200 euros
Trainee / Postgraduate: 100 euros
Nurse or paramedic: 100 euros
BESEDIM Membership Fee 2017 (to pay separately)
Emergency Physician: 150 euros
Trainee / Postgraduate: free!
Other: 100 euros
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