Registration Form EDUCATIONAL GRANT - REGISTRATION FORMConference participation - Free Conference participation - Free Hotel Walhalla - Single Room (Optional) Single Room - Wednesday September 20 - € 170 Single Room - Thursday September 21 - € 170 Single Room - Friday September 22 - € 170 Total Amount PERSONAL INFORMATIONName* First Last Hospital or Institute*This info will appear on your personal name tagEmail* Mobile phone number (with country code)*Dietary wishes (optional)INVOICE DETAILSConf ParticipationWalhalla - Single - Wednesday September 20 Prijs: Walhalla - Single - Thursday September 21 Prijs: Walhalla - Single - Friday September 22 Prijs: Company or Institute*Department / Contact person (optional)Address*Postal Code*City*Country*EmailDit veld is bedoeld voor validatiedoeleinden en moet niet worden gewijzigd.
