Registration Brussels (for committee members/late registration)

Full name *

Date of Birth *

Email *

Emergency contact phone *

Emergency contact name *

Do you have any medical conditions or dietary restrictions we should know off? (Note: only breakfast at the hostel is included in the fee) *

• Participation fee (€ 24,50)

Amount *
€

Payment method *
iDEAL Krediet-/ Debetkaart SOFORT Banking
I hereby give authorization to collect the recurring amount from my account periodically.

Submit