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First Name
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(Facultatif)
Last Name
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(Facultatif)
E-mail Address
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(Facultatif)
Position / Job Title
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(Facultatif)
Institution / Organisation / Hospital
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(Facultatif)
Dietary preferences
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(Facultatif)
Will you be able to attend the whole duration of the scientific programme?
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Yes
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(Facultatif)
No
*
(Facultatif)
If no please specify: …
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(Facultatif)
If no please specify:
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(Facultatif)
Would you like us to book a hotel stay for you (maximum of 2 nights, free of charge)?
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Night of 20–21 November
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(Facultatif)
Night of 21–22 November
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(Facultatif)
I do not require a hotel room
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(Facultatif)
Please indicate which transfers you would like to use (free of charge):
*
21 November - 07:30 – From Moxy Antwerp to UZA
*
(Facultatif)
21 November - 17:10 – From UZA to Licoli
*
(Facultatif)
22 November - 07:30 – From Moxy Antwerp to UZA
*
(Facultatif)
22 November - 12:30 – From UZA to Moxy Antwerp
*
(Facultatif)
Please indicate your meal preferences by ticking all options that apply
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I wish to attend the Friday evening dinner (17:30-19:00h at Licoli)
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(Facultatif)
I would like a takeaway lunch bag on Saturday
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(Facultatif)
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The personal data provided will be used solely for the purposes of organizing this symposium. Your information will not be shared with third parties and will be deleted after the event, unless otherwise agreed.
By providing your details, you consent to this use, and you also agree that photos and video recordings may be taken during the event. These may be used for internal reporting or external communication related to the symposium.
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