Update in Abdominal and Urogenital Imaging 2019 Online regsitration form



Thank you for using our website for your registration for the Update in Abdominal and Urogenital 2019 Meeting, October 3^rd - 5^th, 2019 in Bruges - Belgium. The procedure is quite easy and consists of 4 steps:
	1. Submit your personal data
	2. Make your registration
	3. Make a payment through your creditcard or by banktransfer .
	4. Confirmation of registration request.
IMPORTANT : Please understand that for your registration to become firm, we have to receive the complete payment. If needed, you will receive an official certificate of payment.



To Avoid Technical Difficulties PLEASE DO NOT Click on the "BACK Button" while using the on-line registration system. Thank you.



Title:
Family name	(*)
First name	(*)
Institution/University
Department
Street address:
Zipcode:	City :
Country:
Telephone:
Faxnumber:
Email address:	(*)
VAT number:
Invoice address: (1)

Special Dietary requests:

(1) if different than street address !

IMPORTANT :

We want to inform you that the information you are submitting will be treated under the legislation concerning private information and the General Data Protection Regulation of the EU.

I wish to receive information about Future events of the Update in Medical Imaging Group.



Choose a category
(more information)

Regular Delegate, full meeting
BSR - Member, full meeting.
Resident, full meeting
Resident-YRS member, full meeting

Regular delegate for 1 day:
BSR - Member, for 1-day:
Resident for 1 day:
Resident YRS member for 1 day:

BRS Members: BRS members have to submit RIZIV / INAMI number and BSR membership number.
	RIZIV / INAMI number:
	BSR membership number:

Resident YRS-Members: BRSYRS members have to submit RIZIV / INAMI number and YRS membership number.
	RIZIV / INAMI number:
	YRS membership number:

Click here, if you are bringing an accompanying person

(What is included ?)



Accompanying person's name: Mrs. Mr.