Volunteer pre-registration form

Fill in only if you are not already registered to our panel

Surname *

First name *

Date of birth *

Sociale security No. *

Adresse :

Street *

Postcode *

Town/City *

Mobile Phone *

Landline

E-mail *

Availability *:

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Profession *:

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How did you hear about the BIO-EC Laboratory?

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By submitting this form I accept that the information entered will be added to our voluntary database and used for cosmetic clinical studies.

To know and exercise your rights, including the withdrawal of your consent to the use of the data collected by this form, please consult our privacy policy.