21st International Dental Congress

TDA
st
21 International Dental Congress
28-30 May 2015 • Istanbul Congress Center
Registration Form
Name Surname
: ..................................................................................................................................................................................................................................................
Occupation
:
Dentist
Specialised Dentist
Academician
Technician
Dental Assistant
PhD & Post Graduate Student
Student
Company Representatives
Title
:
Prof. Dr.
Assoc. Prof. Dr.
Dr./PhD
Specialised Dentist
PhD Student
Instution
:
Oral Maxillofacial Surgery
Oral and Maxillofacial Radiology
Pediatric Dentistry
Endodondics
Periodontics
Prosthodontics
Restorative Dentistry
Other
Orthodontics
Address
: ....................................................................................................................................................................................................................................................
Phone
:............................................................................ Mobile:............................................................................ Fax:............................................................................
E-Mail
: ....................................................................................................................................................................................................................................................
REGISTRATION TYPE
Registration Fee for
(Until April 06th, 2015) (Until May 11st, 2015)
Scientific & Social Program
Dentist
(After May 11st, 2015)
Registration Fee for
Scientific Program
(Until April 06th, 2015)
(Until May 11st, 2015)
(After May 11st, 2015)
310 €
Dentist
190 €
220 €
250 €
210 €
240 €
New Graduates*, PhD and
Postgraduate Student
120 €
150 €
180 €
200 €
230 €
260 €
Dental Technician
140 €
170 €
200 €
130 €
160 €
190 €
Dental Students
70 €
100 €
130 €
Dental Assistant
130 €
160 €
190 €
Dental Assistant
70 €
100 €
130 €
Accompanying Person
160 €
160 €
160 €
Accompanying Person
100 €
100 €
100 €
250 €
New Graduates*, PhD and
Postgraduate Student
180 €
Dental Technician
Dental Students
280 €
*Graduated from Faculties of Dentistry in 2010 and beyond.
Registration Fee for Scientific and Social Program includes:
Entrance to scientific sessions and exhibition area, congress documents , congress bag
lunches, coffee breaks, gala dinner, bosphorus tour
Accompanying Person - Social Program Included Registration fee includes:
Congress name badge, opening ceremony, closing ceremony,entrance to exhibition area,
Istanbul city tour, gala dinner, bosphorus tour
Daily Registration
Fees
Dentist
110 €
Dental Students
25 €
Daily Registration Fee includes:
Entrance to scientific sessions and
exhibition area,
congress documents,congress bag,
Lunches, coffee breaks
*Graduated from Faculties of Dentistry in 2010 and beyond.
Registration Fee for Scientific and Social Program includes:
Entrance to scientific sessions and exhibition area, congress documents , congress bag
lunches, coffee breaks
Accompanying Person - Social Program Included Registration fee includes:
Congress name badge, opening ceremony, closing ceremony,entrance to exhibition area,
Istanbul city tour
Social Program
Fees
Gala Dinner
90 €
Bosphorus Tour
110 €
• Accommodiation & Hands-on course registrations will be displayed at official congress website.
www.istanbuldental.org
Official VAT is included in the all registration fees.
Total Registration Fee: .............................................€
PAYMENT OPTIONS
Bank Transfer
Holder
: Istanbul Dishekimleri Odasi
Bank
: Turk Ekonomi Bank
Branch / Branch Code : Harbiye Branch / 380
Swift Code
: TEBUTRIS
Account
: 7720303
Euro IBAN
: TR37 0003 2000 0000 0027 7203 03
Invoice Informations (If it is different from above)
Please send this form with bank receipt to registration secretariat by
fax or e-mail. Registrations sent without payment receipt will be
added to waiting list, until necessary documentation is received.
Please kindly note that; all transfers should made net of bank charges.
: ……………………………………………………………………………………….....................……....…
Participant Name (if different) : ……………………………………………………………………………………….....................……....…
Credit Card Number
: __ __ __ __
CVV2 Code
:
Expiry Date (mm/yy)
:
__ __ __ __
__ __ __ __
AMEX
............................................................................
Address: ..............................................................
............................................................................
VAT No: ..............................................................
Credit Card Payment
Card Holder’s Name
Company Name: ..................................................
__ __ __ __
VISA
MASTER CARD
SIGNATURE
Cancellation & Refund Policy
All booked registration services cancelled
before April 6th, 2015 are 100% refundable
All booked registration services cancelled between
April 6th – May 11st , 2015 are 50% refundable
No refunds for cancellations made after May 11st,
2015. All cancellations must be sent to TDA 2015
Registration Secretariat. All refunds will be executed
after the end of the TDA 2015 International Dental
Congress.
I accept above cancellation policy and I authorize the payment of the total amount indicated above to be debited from the credit card indicated above by IDO.
Please send this form by fax (+90 (312) 446 41 24) or e-mail ([email protected])