Registration form EUPRIO Belgium 2018

The fees for 2018 amount to 125 € for an individual registration (1 person) and 250 € for an institutional registration (from 1 to 4 persons from the same institution). An institution can subscribe to several institutional memberships and therefore register more than 4 members. The membership is personal and it is implied that only the registered member is entitled to make use of it.

The amount is to be paid on the following bank account: 735 0079976 36 (IBAN: BE46 7350 0799 7636, BIC-code: KREDBEBB) with GIEUPRIO in communication. If you would like to receive an invoice, please tick the box ‘Invoice’.

(Please fill out this form for both renewal or first time registration)

Mr/Ms:* 
First Name:* 
Last Name:* 
Function:* 
Name of the institution:* 
Address:* 
ZIP code:* 
City:* 
E-mail:*   
Phone:* 
GSM:
Invoice:* 
Type of membership:*
 


*  required fields
EUPRIO Belgium (wouter.depesseroey@uantwerpen.be) is collecting these personal details for the organization of the EUPRIO Conference and the national activities. If you want to change your personal details or have them removed from our database, please inform us using the address above. Under no circumstances will these details be given to third parties. More information about our privacy policy: www.uantwerpen.be/disclaimer.