EU-JUST-CT Workshop Registration Form
28-29th Sept 2023, Hotel Parc Belle-Vue, Luxembourg
Title
Please Select
Dr
Mr
Ms
Prof
-
Name
*
First Name
Last Name
Email
*
example@example.com
Your Country
*
Please Select
Austria
Belgium
Bulgaria
Croatia
Czechia
Cyprus
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Ireland
Israel
Italy
Latvia
Lithuania
Luxembourg
Malta
Netherlands
Norway
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
Sweden
Switzerland
United Kingdom
Capacity in which I will attend the workshop
*
Please Select
European Commission representative
Project team member
Project Advisory Group member
Project Steering Group member
National radiology society representative
National radiation protection authority representative
National health authority representative
Health professional (pls specify profession)
Patient representative
Other
If 'Other', please provide details
Affiliation (how you wish your affiliation to be listed in the attendance list)
*
Thursday 28th September (13:00 - 17:30)
*
I will attend
I will NOT attend
Friday 29th September (09:00 - 16:10)
*
I will attend
I will NOT attend
If you plan to attend, please list any allergies and/or dietary requirements below
Please provide any other comments you have for the organizer in advance of the workshop.
This online registration alone does not guarantee a place in the workshop. I acknowledge that my place in the workshop is secured only upon email confirmation from the project office.
*
Agree
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