Registration form

Mr./Ms. *

Title

First name *

Last name *

Category

ESPR Member

Non-ESPR member physician

Resident ESPR Member (certified by head of department)

Resident non-ESPR Member (certified by head of department)

Radiographer

For residents: please submit a letter by the head of your department to r.r.vanrijn@amsterdamumc.nl certifying your training status.

Will attend the course dinner (75 € incl. drinks, to be paid at registration).

Yes

Email address *

Ticket selection required, however there are no tickets available. Please contact the organiser.

Registration fee options