Registration form

Registration is necessary to attend the symposium for one or two days. Please, complete this form.

The fees must be paid in the time of registration.

Registration fees

Nephrologist
Physician in training
Reference nurse

Payment by bank transfer

Account number : BE47-2100-6670-0080

SWIFT code : GEBABEBB

Reference : 226D-DEH Symposium + name

Beneficiary : Cliniques Universitaires St.-Luc

Registration form


I take part in
I have been informed about the symposium by :