EYC BREAST IMAGING WORLD TOUR - Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

+++ MEET UP & DRINKS +++
on Tuesday, March 9, 2021, from 17:00 to 19:30 CET
Prepare a pink cocktail, dress up and post your picture on twitter @eusobiyc – the best picture will receive a prize!

Register now & don't forget to tell us your favourite song(s)!
The access details to this online event will be sent to you by email on the day before the event.

Firstname *

Lastname *

Email address *

City *

Country *

Tell us your favourite song(s)! We will try to add it/them to the playlist for the Virtual Dance Party.

Personal Data *

I hereby consent to the processing of my above given personal data by EUSOBI for the purpose described above. Further information concerning the processing of your data can be found here: https://www.eusobi.org/data-protection/

Required

I agree that my personal data, consisting of my full name, profession, working place and email address may be disclosed to the sponsor of the online event. *

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms