Registration

Please register here for the LRCB Breast Cancer Screening Course 2023.

Course dates: April 17-21, 2023

This order form is provided via aanmelder, offering a secure (https) website for transmission of your data to the EUSOBI Office.

In case of any questions, please contact office@eusobi.org.

Kindly note, course places are limited.

Personal Information

Mr./Ms. *

Mr.

Ms.

Other

Title

First name *

Last name *

Date of birth *

Profession *

Contact Information

Email address *

Country *

Postal code *

City *

Street *

Street No.

Phone number *

Hospital *

Department *

Do you need a different address on your invoice/receipt? *

Yes.

No, same address as indicated above.

Company / Hospital name (if applicable)

VAT number (if applicable)

Country *

Postal code *

City *

Street *

Street No.

Payment

Please choose your registration fee: *

EUSOBI Member Registration: € 1,250.00

Non Member Registration: € 1,350.00

Payment Method *

Credit card (Mastercard or Visa)

Bank transfer

Account name: EUSOBI - European Society of Breast Imaging
IBAN: AT972011100005151058
BIC/SWIFT: GIBAATWWXXX
Bank name: Die Erste Bank
Bank code: 20111

Please indicate your full name and “Breast Cancer Screening Course 2023 April” on transfer documents for identification purposes. Kindly note that you are responsible for any bank charges that might apply. As soon as a sufficient number of applicants has been achieved, the EUSOBI Office will advise you of doing the payment.

The registration fee is charged on behalf of the Dutch Expert Centre for Screening (LRCB).

Credit card

If you have chosen credit card as your preferred payment method, please indicate your credit card details below. As soon as a sufficient number of applicants has been achieved, the EUSOBI Office will charge the course fee.

The registration fee is charged on behalf of the Dutch Expert Centre for Screening (LRCB).

Name of card holder *

Card number *

Expiration date (MM/YY) *

CVV2 (3 digit numbers on back of your Visa/Mastercard) *

I herewith authorize EUSOBI to charge the credit card indicated above. This payment authorization is for the service described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company, so long as the transaction corresponds to the terms indicated in this registration form. *

Terms & Conditions

Please carefully read and confirm the terms and conditions, data protection policy and legal disclaimer.

I have read and accept the Terms and Conditions. *

I have read and acknowledge the data protection policy and legal disclaimer. *

Personal Data Disclosure - I agree that my personal registration data is forwarded to the LRCB (course organiser). *

I agree to receive EUSOBI news, newsletters and information about future scientific and educational events and product developments related to the field of radiology.

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