#BHCT19 Connected Health Conference Registration form
Take your chance to be part of the future and join us on Saturday 23.03 at Rogier Hotel Crowne Plaza, Brussels
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Email address
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Your email
Last Name
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Your answer
First Name
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Your answer
Organization/Company
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Your answer
Function
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Your answer
Choose your entry ticket for #BHCT19 :
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175 EUR - I am a MEMBER of BHCT/in4care and I want to register for #BHCT19 !
200 EUR - I am NOT a MEMBER of BHCT nor in4care and I would like to register for #BHCT19
225 EUR - I am NOT a MEMBER of BHCT, I would like to become a member of BHCT and register for #BHCT19
PAYMENT METHOD
Veuillez payer par virement sur compte BHCT avec mention BHCT19 suivie de votre nom
Gelieve te betalen via storting op rekening BHCT met vermelding BHCT19 gevolgd door uw naam
Please pay by deposit on BHCT mentioning BHCT19 followed by your name
BHCT BANK ACCOUNT
Av.Franklin Rooseveltlaan 82 Bte 9
1050 Brussels
BE42 3631 7037 2254
A copy of your responses will be emailed to the address you provided.
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