REGISTRATION FORM FALL MEETING NVMM-VIZ-BVIKM/SBIMC November 16 and 17, 2017 in , Sint Michielsgestel, The Netherlands Please fill in and send to . You will receive an invoice for payment. PAYMENT received before October 1st, 2017 (for payment after October 1st, an additional 25 EURO will be charged) PAYMENT by bank transfer, Full meeting* One day* received before October 1st, (Thursday and Friday) 2017 Members NVMM, VIZ, 120 Euro Thursday, 80 Euro Friday, 80 Euro Graduating student and 90 Euro Thursday, 50 Euro in training Friday, 50 Euro All other attendees 200 Euro Thursday, 125 Euro Friday, 125 Euro Dinner Thursday 45 Euro 45 Euro Social Event free free I expect to arrive by public Yes Thursday Yes transportation and would No Thursday No appreciate a shuttle bus from Friday Yes train station Den Bosch to the Friday No venue at start and end of the day I will attend the Meeting of the Yes Dutch Antibiotic Stewardship No teams (November 16, 9.00 – 11.30) - free *: please tick the appropriate circle(s) HOTEL You can book a hotel room through Enter Arrival and Departure dates, and fill in the Code: NVMM YOUR DATA Last name Initials Title Institution Department address Member of NVMM / VIZ / BVIKM-SBIMC BIG nummer (NL)
REGISTRATION FORM FALL MEETING NVMM-VIZ-BVIKM/SBIMC November 16 and 17, 2017 in , Sint Michielsgestel, The Netherlands Please fill in and send to . You will receive an invoice for payment. PAYMENT received before October 1st, 2017 (for payment after October 1st, an additional 25 EURO will be charged) PAYMENT by bank transfer, received before October 1st, 2017 Full meeting* (Thursday and Friday) One day* Members NVMM, VIZ, 120 Euro Thursday, 80 Euro Friday, 80 Euro Graduating student and in training 90 Euro Thursday, 50 Euro Friday, 50 Euro All other attendees 200 Euro Thursday, 125 Euro Friday, 125 Euro Dinner Thursday 45 Euro 45 Euro Social Event free free I expect to arrive by public transportation and would appreciate a shuttle bus from train station Den Bosch to the venue at start and end of the day Yes No Thursday Yes Thursday No Friday Yes Friday No I will attend the Meeting of the Dutch Antibiotic Stewardship teams (November 16, 9.00 – 11.30) - free Yes No *: please tick the appropriate circle(s) HOTEL You can book a hotel room through Enter Arrival and Departure dates, and fill in the Code: NVMM YOUR DATA Last name Initials Title Institution Department address Member of NVMM / VIZ / BVIKM-SBIMC BIG nummer (NL)
registration-form-fall-meeting.docx