Individual Registration

Registration form 2nd European Renal Pathology Crash Course, 12-13 October 2017, Amsterdam, the Netherlands

The registration fee is 500 euros for nephrologists and residents (this is including the course dinner on Thursday October 12).

Please fill in the form below:

salutation*
first name*
family name*
age
speciality:
hospital/organisation*
department
address 1*
address 2
city*
country*
zip/postal code*
email*
email (verification)*
telephone
will attend course dinner on
Thursday October 12 (included in registration fee):

yes:  || no: 
dietary requirements
BIG registration code
(for dutch participants only)

enter security code*

please click submit to complete your registration

*: required fields

Please transfer the registration fee before September 1 2017 to:
Stichting KPA
ABN AMRO Bank
Meibergdreef 9, 1105 AZ Amsterdam
IBAN: NL14ABNA0546937136
BIC/SWIFT: ABNANL2A
mentioning '2nd European Renal Pathology Crash Course'.
No refunds will be made after September 15 2017.
Clause: with an insufficient number of applications the course organization preserves the right to cancel the course.