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Please fill the registration form below to register for Impact of Science on 4 and 5 June 2015 in Amsterdam. You can find more information about the conference and its program on the dedicated web pages. The core information: 

  • When: 4 and 5 June, 2015
  • Where: Amsterdam, the Netherlands
  • Attendance fee: € 450*
  • Remote attendance fee: € 95*
  • Optional: Conference dinner on 4 June: € 60*

* all amounts are excluding VAT (BTW).

Surname
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Please provide your family name.
First Name
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Please provide your given name.
Initials
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Please provide your initials.
Salutation ?
Please let us know how you would like to be addressed.
Title
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Please provide your relevant academic (or other) titles.
Organisation
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Please provide the name of the organisation you represent, if any.
Department
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Please provide the department of the organisation you represent.
Function
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Please provide your function in the organisation you represent.
Address
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Please provide your address details.
Postal code and City
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Please provide the postal code (if any) and city
Country
Email address
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Please provide your personal email address where we can send further communication.
Phone number
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Please provide your phone number, including international prefix in the form of 0031-123456789
Mobile
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Please provide your mobile phone number.
Preferred track 4 June block III ?
Please let us know what track you plan to follow on 4 June during block III
Preferred track 4 June block IV ?
Please let us know what track you plan to follow on 4 June during block IV
Preferred track 5 June block I ?
Please let us know what track you plan to follow on 5 June during block I
How did you find out about Impact of Science
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Please let us know how you found out about Impact of Science, to help us improve our service.
Other way you found out about this conference:
Dietary requirements:
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Please let us know if you are vegetarian or have specific dietary requirements. While we can't promise that we can arrange everything we will do our best.
Special invitation code (if appliccable):
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Please provide the coupon code you received to register at a reduced fee (for example, as a speaker or invitee by a partner)
I will attend: ?
This dinner is organized exclusively for the conference participants and speakers. Limited availability. * Costs are exclusive 21% VAT.
Payment preference: ?
Please select your payment option. Paying with a credit card unfortunately results in higher transaction costs. In case you have an invitation code please select 'I will pay the invoice via bank transfer' and ignore the invoice details below.
Invoice details ?
Please write your reference or other invoice details here
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You can find the conditions of the event on http://science-works.nl/impact-of-science-2015/ under the tab "register and conditions".

Impact of Science

Measuring and demonstrating the societal impact of science

De Balie, Amsterdam, 4 and 5 June 2014