Title

First name *

Prefix

Last name *

Institution *

Department *

E-mail *

Phone

Address

Postal code

City

Country

Gender *

Basic/Clinical research *

Are you an NVTH member? (yes/no) *

NVTH member #

BIG registration #

Are you a PhD student? *

Will you defend your PhD thesis before the start of the PhD course? (yes/no) *

Are you a first time participant? (yes/no) *

If yes, upload NVTH Trainee Statement (after payment) (yes/no)

Optional remarks

Payment options *
PhD course (€ 300,00)

Amount *
€

I hereby register to and accept the terms and conditions as described below *

Payment method *

• Credit card
• iDEAL

Complete registration