Registration form Courses Radiation Protection Unit

Last name (Family name)*

First name (Given name)*

Date of birth*

Place of birth (City/town)*

Country of birth*

E-mail address*

Institution *

Specify

Department*

Position*

Budget number (internal employee) or invoice address (external participant)

Invoice (if applicable)*

sent to course participant

The invoice is issued in the name of the participant (add information to the 'Remarks' field)

sent to employer

The invoice is issued in the name of the employer of the participant (add information to the 'Remarks' field)

not applicable

Internal participants are exempt from the course tuition

I would like to participate in: *

Remarks