Registration form

15th Congress of the European Skull Base Society

5 - 8 June 2024

Deadline registration fees:

early fee: until 1 April 2024
pre-registration fee: 1 April - 1 June 2024
onsite fee: from 1 June 2024

Please complete the registration form below

Mr./Ms. *

Mr.

Ms.

Title

First name *

Last name *

Email address *

Specialty *

Other

Institute *

City *

Country *

BIG number (if applicable)

Are you an ESBS member? *

Yes, I am a member

No, I am not a member

I would like to register as industry staff

If you would like to become a member, please visit the ESBS website for your memberschip application. Please note: do not complete this registration before receiving your membership confirmation.

I would like to register for a: *

Full congress badge - ESBS member - onsite fee

Full congress badge - Resident, fellow, allied healthcare professional - onsite

Invited faculty

Day badge

LOES day badge (Dutch Skull Base Society only)

I would like to register as: *

Full congress badge - Non-members - onsite fee

Full congress badge - Resident, fellow, allied healthcare professional - onsite

Invited faculty

Day badge

LOES day badge (Dutch Skull Base Society only)

I would like to register as: *

Industry staff

Day badge member: *

Day 1: 5 June 2024

Day 2: 6 June 2024

Day 3: 7 June 2024

Day 4: 8 June 2024

Price day 1 badge: *

ESBS member - onsite fee

Resident, fellow, allied healthcare professional - onsite

Invited faculty

Price day 2 badge: *

ESBS member - onsite fee

Resident, fellow, allied healthcare professional - onsite

Invited faculty

Price day 3 badge: *

ESBS member - onsite fee

Resident, fellow, allied healthcare professional - onsite

Invited faculty

Price day 4 badge: *

ESBS member - onsite fee

Resident, fellow, allied healthcare professional - onsite

Invited faculty

Day badge non-member: *

Day 1: 5 June 2024

Day 2: 6 June 2024

Day 3: 7 June 2024

Day 4: 8 June 2024

Price day 1 badge non-member: *

Non-member - onsite fee

Resident, fellow, allied healthcare professional - onsite

Invited faculty

Price day 2 badge non-member: *

Non-member - onsite fee

Resident, fellow, allied healthcare professional - onsite

Invited faculty

Price day 3 badge non-member: *

Non-member - onsite fee

Resident, fellow, allied healthcare professional - onsite

Invited faculty

Price day 4 badge non-member: *

Non-member - onsite fee

Resident, fellow, allied healthcare professional - onsite

Invited faculty

Congress Diner Ticket

Please note: If you have already registered for the congress, but would also like to purchase a ticket for the congress dinner, please email events.rha@radboudumc.nl

Congress diner: *

1 ticket - early fee

2 tickets - early fee

I will not attend the congress diner

Bijdrage

Neurofibromatose Vereniging Nederland

Option 2

Option 3

Overnachting Hoogeweerth

ticket fee Dirk Kunst

ticket fee C. Delsing

Option 3

Board diner Kruisheren hotel

ticket fee

Option 2

Option 3

Cancellation policy

Cancellation of registration has to be made in writing to the conference secretary (events.rha@radboudumc.nl)

Refunds will be provided as follows:
1.    for cancellations received 3 months or more prior to event - 95% refund
2.    for cancellations received 2 months prior to event - 80% refund
3.    for cancellations received 1 month prior to event - 50% refund
4.    for cancellations received 14 days prior to the event - 25% refund
5.    for cancellations received less than 14 days prior to the event - no refund

I accept the cancellation policy as described above *

Congress diner: 1 ticket - early fee

1

€ 130.00

Group registration

€ 2,000.00

Total: € 130.00