REGISTRATION FORM - Immunity for Health 2022
	Choose your formula* Flanders Vaccine member*: 150 EUR (+21% VAT) Flanders Vaccine non-member / Academic or non-profit: 200 EUR (+21% VAT) Flanders Vaccine non-member / Industry: 300 EUR (+21% VAT) Students (bachelor/master, PhD students): 50 EUR (+21% VAT) Sponsor/exhibitor **
	Choose your Sponsorship package Conference Sponsorship Catering Sponsorship Research & Networking Sponsorship Exhibition Booth & Branding Sponsorship Click on the sponsorship options to see more info
	Choose your Conference Sponsorship package Platinum Sponsor (4000 EUR) Gold Sponsor (3000 EUR) Silver Sponsor (2000 EUR)
	Choose your Catering Sponsorship package Lunch Sponsor (2000 EUR) Coffee Break Sponsor (1000 EUR) Networking Reception Sponsor (1500 EUR) Combined Catering Sponsor (3500 EUR)
	Choose your Research & Networking package Pitch Award Sponsor (please contact us) Networking tool Sponsor (2500 EUR)
	Choose your Branding Sponsorship package Exhibition Booth (1500 EUR) Advertisement in programme book (500 EUR)
	* Check here if your organisation is a member ** Please contact us if you're interested in supporting this event
	Do you require an invoice?* Yes No

	DELEGATE INFORMATION
	Company / Organisation*
	First name*
	Last name*
	Function title*
	Email address*

	BILLING INFORMATION
	Company / Organisation*
	Contact person First Name Last Name
	Email for invoicing* Your invoice will be sent to this address
	Address*
	Zip code*
	City*
	Country*
	VAT*
	Purchase Order Number

	PAYMENT INFORMATION A payment request will be sent by email and can be paid by bank transfer or creditcard.
	Name* First Name* Last Name*
	Email*
	Phone

	Will you attend the networking reception (5 – 6 PM)?* Yes No Don't know yet
	If you have special dietary requirements (vegetarian, gluten free…), please indicate in the text box below:
	Do you wish a certificate of attendance?* Yes No
	Would you like to be informed about future Flanders Vaccine activities?* Yes No

	General Terms & Conditions and Privacy Statement* I agree with the General Terms & Conditions and with the Privacy Statement of Flanders Vaccine, available on flandersvaccine.be
	Cancellation Policy* I agree that notifications received upon 2 weeks before the start of the event, get refunded for 100%. Cancellation requests received less than 2 weeks before the start of the event won't be refunded. No-shows on the day of the event, will not be refunded and are requested to pay the full fee. Replacement by a colleague is always allowed and should be reported to the organizers.