System.ArgumentOutOfRangeException: Index was out of range. Must be non-negative and less than the size of the collection. Parameter name: index at System.Collections.ArrayList.get_Item(Int32 index) at System.Web.UI.WebControls.ListItemCollection.get_Item(Int32 index) at AzSintJan.Congres.ucCongres.TranslateForm() AZ Sint-Jan Brugge-Oostende AV
Spoedgevallen campus Sint-Jan
050 45 20 00
Spoedgevallen campus Henri Serruys
059 55 51 01
EBTA2016 >  Registration

Registration

In case this form isn't working properly, please contact stefanie.vanpachtenbeke@azsintjan.be.

With this form you can send an application for registration to the organizers.
You will be registered when you receive a confirmation.


General information*"

Saluation
Name
First name
Language
Betaling door

Professionele gegevens

Instelling/firma**
Werk straat**
Werk postcode**
Werk plaats**
Werk land**
 
Werk rekeningnummer
Werk BIC
Werk IBAN
 
Werk e-mail**
Werk telefoon**
Werk GSM
Werk fax

Persoonlijke gegevens

Privé straat***
Privé postcode***
Privé woonplaats***
Privé land***
 
Privé rekeningnummer
Privé BIC
Privé IBAN
 
Privé e-mail***
Privé telefoon***
Privé GSM

Kies uw activiteiten*

- Time: 22/09/2016 13:00 until 22/09/2016 17:30
- Places available: 73 out of
- Time: 22/09/2016 19:00 until 22/09/2016 22:00
- Places available: 175 out of
- Time: 23/09/2016 10:00 until 23/09/2016 23:55
- Places available: 98 out of
- Time: 23/09/2016 10:00 until 25/09/2016 16:00
- Places available: 245 out of
- Time: 24/09/2016 19:00 until 24/09/2016 19:01
- Places available: 149 out of
- Time: 26/09/2016 10:00 until 26/09/2016 17:00
- Places available: 83 out of

Opmerkingen


* verplicht in te vullen
** verplicht in te vullen indien betaling door instelling/firma
*** verplicht in te vullen indien betaling door privépersoon

inschrijven