#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
Email address *
Last Name *
Your answer
First Name *
Your answer
Organization/Company *
Your answer
Function *
Your answer
Choose your entry ticket 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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