Simovision | Event Subscription Form

Welcome

By filling out this form, you confirm being an Ophthalmologist or Medical Professional active in Benelux.

Event:*

Please select the Event you wish to attend.

personal data

First name:*

Please enter your First Name.

Last name:*

Please enter your Last Name.

E-Mail address:*

Please enter your E-mail address.

UZ AntwerpUZ BrusselsUZ GentUZ Louvain

I want to attend to the Dinner on January 30th (Friday).I will not attend.

Dietary restrictions:

Please indicate when applicable.

VAT Number:

Please type in your VAT Number when applicable.

I want to stay overnight.I do not want to stay overnight.

I have read and hereby accept the Privacy Policy*.

* While using this Subscription Tool, you agree to the Privacy Policy Terms on our Website (which can be consulted in Dutch or in French).