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Registration form

 
 
REGISTRATION FORM
For the XIV th IVAS Hybd course in Belgium 2017-2018
 
 
     B E V A S
                                                                                                              Belgian Veterinary Acupuncture Society vzw                                                                                              
 
 
 
 
Name of licensed veterinarian: ____________________________________________

Veterinay Universiy and year of promotion: __________________________________

 
Address: ______________________________________________________________
 
 
Country: ______________________________________________________________
 
 
ID card- or passport nr: ___________________________________________________
 
 
Tel: ___________________________________________________________________
 
 
Fax: __________________________________________________________________
 
 
E-mail: ________________________________________________________________
 
 
“I have read and accept the general registration information”, 
 
 
Date & Signature :
 

 

 

AttachmentSize
REGISTRATION FORM.doc57.5 KB
GENERAL REGISTRATION INFORMATION2016.doc24 KB