Virtual Prostate MRI Course 7-9 October 2021

I register as *

participant (2/30)

Mr. / Ms. *

First name *

Last name *

Title *

Hospital *

City *

Country *

What is your mobile number? *

Email address *

BIG-number

How many years of experience in Prostate MR do you have *

Terms and conditions

By submitting this form I accept the registration fee of euro 1,900 and the cancellation fee of euro 500 when cancelling after September 1st, 2021. *

Please note:

If you would like to pay by invoice, make sure to follow the next steps:

on the next page you can fill out your invoice details
click on the blue button 'Pay online'
you will enter a payment page (Buckaroo) where you have to select 'SEPA Transfer'
You will be asked to fill out your name and emailaddress
By proceeding, your registration will be finalised and you will receive an email with a confirmation of your registration and the invoice

Participant

€ 1,900.00

Total: € 1,900.00

Registration form