PHM Summer School registration

I want to apply for the:*
Information participant
First name*
Last name*
E-mail address*
Phone number
BIG nr. (if applicable)
Information organisation
Category profession*
- Professional
- PhD-student
- Master student
Profession description*
Organisation
Address
Postal code
City
invoice information
Name on invoice*
E-mail address invoice*
Name contact person invoice*
Address invoice*
Postal code invoice*
Mailbox (if applicable)
City for invoice*
Other comments and dietary preferences:
General, cancellation- en privacy terms*
Hereby I agree with the algemene voorwaarden, annuleringsvoorwaarden en privacy voorwaarden.
- Yes
Payment*
I hereby agree to direct payment after registration
- Yes
By registering for this event you agree that we save your personal information.
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Information participant