Learning Lab - Imaginal Exposure (IE): Registration Form

Registration steps

Registration

Confirm

Confirmed

Registration

Registration*

I hereby confirm my registration for the Learning Lab - Imaginal Exposure on May 3 & 6 2021 19:00-22:00 (CET). See the terms and conditions on www.rino.nl/terms_and_conditions

€ 590,-

Yes, confirm my registration and agree with the terms & conditions

€ 0,00

Personal Details

gender

male

female

not specified

Initials *

First name *

Prefix

Surname *

BIG Registration Number

Email *

Address *

Postal code *

City *

Country

Invoice Details

use postal address for invoicing

Use the above postal address for invoicing

Invoice company

your purchase number and/or administrative reference

invoice attn. *

Invoice Street and number *

Invoice Postal code, or State and ZIP code *

Invoice city *

Invoice country

e-mail for invoice *

Would you like to receive more information on our future online activities?

Yes, I would like to receive more information on future online courses and events.

No, I do not want to receive any further information on future events.

Items marked with an asterisk (*) are mandatory.

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If you are experiencing issues when trying to register please contact us: +31 20 625 08 03 or info@rino.nl