Individual Registration

Please enter your information in the form below to process registration for the IAPM ASM 2018.

First name*
Last Name*
Institution*
Address*
Address2
City*
Country*
State
Zip
Phone*
Email*

IAPM Workshop (Fri 16th Feb) - Free Event *
Yes
No
 
Conference Fee (Saturday 17th Feb only) *
Not Attending (€0)
Professional Member (€50)
Allied-Professional Member (€50)
Trainee Member (€50)
Student Member (€30)
Retired (€30)
Unwaged (€30)
Non Member (€90))
 
Parrallel Session (Saturday 17th Feb)*
Radiotherapy
Diagnostic Imaging
N/A
 

IAPM Member*
Yes
No
 
Conference Dinner (evening of 16th Feb)*
No
Yes (€25)
Delegate + 1 guest (€50)
Delegate + 2 guests (€75)
Delegate + 3 guests (€100)
Delegate + 4 guests (€125)
 
Job Title*
Payment Method * Paypal
Offline or No payment
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