1. Registration

Registration

Registration

Question Title

* 1. Registration

Position

Question Title

* 2. Position

Member of scientific society

Question Title

* 3. Member of scientific society

Friday morning workshop (limited - first come first serve) (€25,-)

Question Title

* 4. Friday morning workshop (limited - first come first serve) (€25,-)

Networking Dinner Ticket {price is included in the registration fee, extra guests are welcome for €50,-)

Question Title

* 5. Networking Dinner Ticket {price is included in the registration fee, extra guests are welcome for €50,-)

  0 1 2 3 4 more than 4 (please e-mail)
number of participants
Please transfer the money for your registration fee, the optional workshop and optional extra guests at the networking dinner to:

Bank Name:                            ING BANK DK Zuid-Holland
Bank Adress:                          Schenkkade 65, 2595 AS DEN HAAG
IBAN:                                     NL07INGB0651205611
SWIFT:                                   INGBNL2A
Account Name:                       LUMC Divisie 1 
p/a Projectenbureau, Postbus 9600, 2300 RC Leiden
Project Reference Number:     ESVS 70786-8204
Do not forget to mention your full name

Question Title

* 6. Please transfer the money for your registration fee, the optional workshop and optional extra guests at the networking dinner to:

Bank Name:                            ING BANK DK Zuid-Holland
Bank Adress:                          Schenkkade 65, 2595 AS DEN HAAG
IBAN:                                     NL07INGB0651205611
SWIFT:                                   INGBNL2A
Account Name:                       LUMC Divisie 1 
p/a Projectenbureau, Postbus 9600, 2300 RC Leiden
Project Reference Number:     ESVS 70786-8204
Do not forget to mention your full name

T