Registration Course

Registration form NVTH PhD course

12,13,14 April 2021 – Online

Title

First name *

Last name *

Institution *

Department *

E-mail *

Phone

Address (for delivery course material!) *

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 Yes/No start of the PhD course/Symposium?

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

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

Optional remarks

Payment options *

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

Payment method *

iDEAL

* Mandatory fields

Deadline PhD course registration: March 25th, 2021

The registration is only valid when both the registration form and the payment have been received.
Cancellation requests can be made until March 25^th 2021. After this date, no restitution will be granted.

You will receive an e-mail confirming your registration.

Your personal data will only be stored and used for registration of the Course 2021.
For more information please contact Yvonne Souverein, secretariat NVTH PhD Course & Symposium:

nvthsymposium@lumc.nl