Annual Symposium 2023

Occupation*

Fill in thuthfully, as this will be checked by the board.

Name*

First Last

Email*

Company / Institute

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I wish to attend*

Monday 12 June
Tuesday 13 June
Both days
Both days including dinner and hotel (1 night)

If you book 1 day, only lunch will be included

I wish to attend*

Wednesday 15 June
Thursday 16 June
Both days
Both days including dinner and hotel (1 night)

If you book 1 day, only lunch will be included

I wish to share a room to reduce cost (-€ 30,-)*

Yes
No

In case you already paid your membership fee for 2023 this can be reïmbursed*

No, I have not yet paid my membership fee
Yes, please reimburse my student membership
Yes, please reimburse my regular membership

The name of the person with whom I will share is:*

Please indicate dietary restrictions

Vegetarian
Pescetarian
Vegan
Gluten-free
Lactose-free
I have no dietary restrictions
Other, please comment at the end of the form

Please indicate your dietary restrictions*

I agree to the following cancellation policy:*

Yes

Reservations can be cancelled up to 4 weeks before the start of the symposium. For cancellation, send a mail to Victor van Beusechem (vw.vanBeusechem@amsterdamumc.nl). The registration costs will be reimbursed. Reïmbursement of the hotel costs is subject to the cancellation policy of the venue.

Total

0,00 €

Choose a payment method*

iDEAL
Credit Card