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Salutation*

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Title

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Initials*

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First name*

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Infix

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Surname*

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Email*

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Confirm email*

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Phone*

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Position/function*

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Company/institute*

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Department*

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Postal address (home or office)*

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Zipcode*

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City*

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Country*

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BIG number

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I need a certificate

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Prescription of medicines*

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Select your ticket

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Please indicate which day you will attend:*

Thursday

Friday

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Please note: You only have to select "Dinner" if you opted for a 1 day ticket and want to attend.
Dinner is included with the 2 days ticket.

Select if you want to attend dinner on Thursday evening. (Only for 1 day tickets)

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Dietary requirements (only if applicable)

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Do you want to book a hotel at the congress venue De Werelt Lunteren?

Yes

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Do you want to share a room?

Yes

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You want to share a room with somebody that has allready booked a room.
Please fill in the credentials of your room partner. Do not book a room as you both will be charged!

Note: do not book a single room for double occupancy!!

Please state the credentials of the other occupant.

Select your hotel room

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Total

0.00 EUR

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Payment

Do you agree to have your name (without contact details) on the list of participants, which will be shared with the sponsors?*

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_ I consent

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