Health by Tech – Registration Form

Registration Form

First name*

Last Name*

Institute*

City*

Email*

Mobile phone number*

Dietary wishes (optional)

Promo Code

Early bird fees

Conference participation - Regular - € 275

Conference participation - Student - € 150

Make a choice

Conference participation - Regular - € 315

Conference participation - Student - € 175

Deelname - Code

Conference participation - Code

Conference Dinner - Thursday Evening

Conference dinner Thursday - € 45

Conference Dinner - Thursday Evening - Code

Conference dinner Thursday - Code

Total

Conference Participation - Early

Prijs:

Conference Participation Student - Early

Prijs:

Conference Participation

Prijs:

Conference Participation Student

Prijs:

Conference Dinner

Prijs:

Conference Participation - Code

Prijs:

Conference Dinner - Code

Prijs:

Institute or Company*

Contact person / Department / PO number (optional)

Address*

Postal Code & City*

Country*

Email

Dit veld is bedoeld voor validatiedoeleinden en moet niet worden gewijzigd.