REGISTRATION FORM
International Masterclass Course in Periodontal and Peri-Implant Plastic Surgery
The official language of the Course is English. Attendance to the Course is open to Graduate Dentists. The Course has a numerus clausus. Applications to participate will be accepted in chronological order until all available places have been taken.
Registration fees (VAT 22% included): € 4.200
Registration includes:
participation in the scientific sessions
coffee-breaks
course materials (for practical exercises as well) and bag
certificate of attendance
Payment:
50%
of the registration fee (equal to € 2.100)
at the time of registration
50%
(balance of the registration fee equal to € 2.100) by
October the 15th 2023
50%
of the registration fee (equal to € 2.100)
at the time of registration by:
-
Wire transfer
to MJ eventi Sas on account No:
IT66 U030 6902 9931 0000 0000 861
SWIFT code:
BCITITMM
at Banca Intesa San Paolo.
Please specify your Surname, Name and International Masterclass Course F Cairo 2023” and attach your receipt to this form
-
Credit Card
The
second and last payment
will be made:
wire transfer to MJ eventi Sas within October the 15th 2023.
credit card October the 15th 2023.
MJ Eventi will send the authorization form to debit the amount due by September 15th 2023.
The registration fee will not be reimbursed if Attendees cancel after enrollment or during the Course
The
registration form will be valid only if fully filled in and sent with a copy of payment of € 2.100=. to:
MJ EVENTI – Organizing Secretariat
Fax +39 055 5059360 • E-mail:
eventi@mjeventi.eu
Participant’s Data
*Name
*Surname
*Address
*Zip Code
*City
*Country
Qualifica Professionale
Odontoiatra
Igienista Dentale
Data di Nascita
01
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*Mobile
*Tel
*Fax
*Email
Invoicing details
*Company Name
Address
*Zip Code
*City
Tax Payer Code no. (mandatory)
Vat Code (mandatory if applicable)