Registration Form

* Certificate confirming residents/paramedics/students status is mandatory.

Without certificate the full fee will be charged.

Please Register me as
Subtotal 1	0
My Payment details
Total Amount	0
Payment	Bank transfer into account number 123-7775440-53 of Congress of the Belgian Society of Physical and Rehabilitation Medicine - RBSPRM IBAN BE53 123777544053 - SWIFT BMOVBE91 Bank address: Graaf Van Vlaanderenplein 19, B-9000 Gent Credit Card
Please mention the participant’s name on all money transfers. All payments must be made without bank charges for the receiver.
Credit Card
Credit Card Holder:
Credit Card Number:
Expiry Date: