Pregnancy in Belgium Pregnancy in Belgium Evening Registration FormAre you already pregnant?*YesNoIs this your first child?*YesNoWhen is your due date?*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Which is your 1st choice?*-- select a pib --21st March 201818th April 201816th May 201813th June 201827th June 2018Which is your 2nd choice?*-- select a pib --21st March 201818th April 201816th May 201813th June 201827th June 2018Your contact details:Participant's First Name* Participant's Family Name* Will your partner be attending?*YesNoPartner's First Name Partner's Family Name Preferred Email* Preferred Phone*Alternative PhoneHow did you hear about the evening?FriendCollagueSmall TalkBCT WebsiteDoctorInternet SearchFacebookAn expat websiteOtherAre you a BCT member?*YesNoWhat's your BCT Number?