Clone of 55th BSRM Scientific Meeting

Registration form - 56th BSRM Scientific Meeting

4-5 December 2026 - Thermae Palace, Ostend

First Name

Last Name

Title

Institute

Street & number

Zip Code

City

Country

Email

Date of birth

DayMonthYear

Language

RIZIV number

Format 1-12345-12-340

Profession

Please specify if chosen "other"

Invoice

Invoice to

Invoice address

Invoice Company

Invoice Title

Invoice First Name

Invoice Last Name

Invoice Department

Invoice Street & Number

Invoice Zip Code & City

Invoice Country

Subject to VAT

Invoice VAT Number

Company registration number

Invoice Remarks

Registration fee is excluded from BSRM Membership fee 2026
I want to participate to the Scientific Meeting (4 - 5 December 2026)

Registration fee:

Late fee (after 15 October 2026)

Registration as:

Hotel: Overnight stay on 4 December 2026. Breakfast, city tax and VAT included.

Name of room partner

Total cost

Payment method:

Total

EURDescription

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Payment policy
Full payment has to be made to the BSRM account with reference: “Name + 56th 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.

CANCELLATION POLICY

Registrations may be cancelled before 15 October 2026, with an administrative fee of €25.

Hotel reservations may be cancelled free of charge before 15 September 2026. After this date, no refunds will be possible. However, you may nominate another participant as your replacement.

All cancellation requests must be submitted in writing by email to the BSRM Central Office: leen@orga-med.com. The date the email is received will be used to determine eligibility for a refund.

Please note that memberships are non-refundable and non-transferable.