Beroepsvereniging-Union professionnelle Psychiatrie

Please fill in the registration form below. After your registration, please transfer the applicable registration fee into the account BE48 7320 2685 6927, mentioning your name, first name and RIZIV-INAMI number.

If you're not a member of the professional association, but decide to join us, you only need to pay the member rate (€ 30 instead of € 80). You will be contacted by the VBS-GBS secretariat for this purpose at a later time.

* indicates required

Email *

Last name *

First name *

Street + nr

Postal code

Place

Institution

Phone

Principal place of employment

Date of birth

RIZIV-INAMI nr