BSMO Registration form 202426th Annual BSMO meeting 2024 Welcome to the registration module IMPORTANT DEADLINES: By 2 January: registration deadline for BSMO members that want to take advantage of a complimentary hotel room. After this date complimentary hotel rooms for members will be upon availability. By 29 January: registration deadline and payment deadline for all. It is only possible to register online. BSMO members and invited speakers are entitled to free participation in the meeting + social programme and complimentary hotel room incl. breakfast and city tax on Friday night NON-members are entitled to free participation in the meeting. However a fee of EUR 80,00 will be charged for the participation in the social programme on Friday evening. No complimentary hotel reservation. Non-members must arrange for their personal hotel reservation. Company representatives of NON-sponsors can sign up and attend the general scientific session open to all. However a fee of EUR 250,00 per day will be charged. Participation in the social programme on Friday evening is not allowed. No complimentary hotel reservation. For questions regarding registration, please contact Mrs Mieke Akkers by e-mail: meeting@bsmo.be PreviousStartPersonal & billing informationI confirm I am BSMO member NON-member (not company representative) an invited speaker a company representative NON SPONSORTitle Prof Dr Mr Mrs MsFirst nameLast NameEmailOrganisation/institute/companyDepartmentFunction– Select –Doctor/specialistResident in trainingGeneral practitionerMedical studentOncocoachResearcherOncology nurseOtherSpecialty– Select –Medical OncologistRadiation OncologistOncologic SurgeonHaematologistUrologistMain field of interest – tumor site– Select –Breast cancerCarcinoma of unknown primary siteCNS malignanciesEndocrine cancersGI cancersGenitourinary cancersGynaecological malignanciesHaematological malignanciesH&N cancersLung and other thoracic tumorsMelanoma and other skin turmorsSarcomasAddress for receipt of paymentStreet+NrCityZip CodeCountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweVAT numberRIZIV / INAMI number – if not applicable type 0 (zero)PreviousNextRegistration detailsClearly indicate below which days/parts you will attend our meeting in Mons. I will attend the lectures on Friday 2 February 2024 the morning lectures on Saturday 3 February 2024 the YOC session on Saturday 3 February 2024 PreviousNext Social programmeNon-members are entitled to free participation in the meeting. However a fee of EUR 80,00 per person will be charged for the participation in the social programme on Friday eveningPlease select the relevant option below I will attend the FULL social programme on Friday evening (walk+dinner) I will attend ONLY the guided walk on Friday evening I will attend ONLY the congress dinner I will NOT attend the social programme on Friday eveningI will bring my partner Yes NoPartner First NamePartner Last NamePreviousNextSocial programme payment Social programme fee NON-memberPrice: 80 €Social programme fee NON-member PARTNERPrice: 80 €Company representative fee for participation on Friday 2 February 2024Price: 250 €Company representative fee for participation on Saturday 3 February 2024Price: 250 €Total fee to pay€PreviousNextHotel reservation RESERVATIONS MUST BE RECEIVED BY 2 JANUARY. AFTER THIS DATE COMPLIMENTARY HOTEL ROOMS ARE UPON AVAILABILITY BSMO covers the costs for your accommodation (including breakfast and city tax) in Van der Valk Congres & Spa Hotel Mons for 1 night* being Friday night 2 February 2024. Extra costs are at your personal expense.Hotel Room Reservation Yes, please book me a SINGLE room in Van der Valk Congres & Spa Hotel Mons for Friday night Yes, please book me a DOUBLE room in Van der Valk Congres & Spa Hotel Mons for Friday night No, I do not require a hotel room reservation *Additional nights can be booked by contacting the hotel directly: info@hotelmons.euHotel reservation RESERVATIONS MUST BE RECEIVED BY 2 JANUARY. AFTER THIS DATE COMPLIMENTARY HOTEL ROOMS ARE UPON AVAILABILITY BSMO covers the costs for your accommodation (including breakfast and city tax) in Van der Valk Congres & Spa Hotel Mons for 1 night* being Friday night 2 February 2024. Extra costs are at your personal expense.Hotel Room Reservation Yes, please book me a SINGLE room in Van der Valk Congres & Spa Hotel Mons for Friday night Yes, please book me a DOUBLE room in Van der Valk Congres & Spa Hotel Mons for Friday night No, I do not require a hotel room reservation *Additional nights can be booked by contacting the hotel directly: info@hotelmons.euHotel reservation NON-members are entitled to free participation in the meeting. No complimentary hotel reservation. For hotel reservations, non members must arrange for their personal hotel reservation. Hotel information can be found herePreviousNextDietary requirements Vegetarian Vegan Lactose intolerant Gluten free OtherOther Dietary requirementsDietary requirements partner for Friday evening dinner Vegetarian Vegan Lactose intolerant Gluten free OtherOther Dietary requirementsPhysical requirements: If you require special facilities to participate in the meeting, please send a detailed description of your needs to meeting@bsmo.beGDPR approval: I allow the organizers of this meeting to keep and use my personal data for mailings on future BSMO activities Yes NoMailing list: I allow the organizers of this meeting to pass on my name and email address to the sponsors of this Annual BSMO Meeting 2024 Yes NoHow did you learn about this BSMO meeting: BSMO mailings BSMO website My institute/colleague Commercial company/SponsorPreviousNextPaymentTotal amount that BSMO will charge you via Mollie€ Previous SUBMIT REGISTRATION
