BSRM Registration

Registration form - 49th BSRM Scientific Meeting

24 March 2023, Greenhouse BXL, Berkenlaan 8A+8B, 1831 Diegem

First Name*

Last Name*

Title*

Institute

Street & number*

Zip Code*

City*

Country*

Vat Number

Email*

RIZIV number

Format 1-12345-12-340

Date of birth

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Language

Profession*

Invoice address

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Invoice Company

Invoice Title

Invoice First Name

Invoice Last Name

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Invoice Street & Number

Invoice Zip Code & City

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Registration fee includes BSRM Membership fee 2023
I want to participate to the scientific meeting (24 March 2023)

Registration as:*

75 Euro - Clinician, reproductive biologist or other40 Euro - Paramedical (midwife, nurse, lab technician) or resident in training, students (Master, PhD, post-doc..)Free - Membership 2023 already paid-up

Calculation

Payment method:

Bank transferVisa / mastercard

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Payment policy
Full payment has to be made to the BSRM account with reference: “Name + 49th Meeting”. IBAN number: BE79 3101 2631 7833, BIC: BBRUBEBB, Bank: ING.

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By registering for the BSRM Scientific Meeting, you agree to receive emails from BSRM & the sponsors.