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.
Participant’s Data

*Name

*Surname

*Address

*Zip Code

*City

*Country

Qualifica Professionale

Data di Nascita
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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)
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 September the 15th 2022


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 2022” and attach your receipt to this form
Credit Card


The second and last payment will be made:

by wire transfer by September the 15th 2022.
By credit card September the 15th 2022. MJ Eventi will sent the authorization form to debit the amount due by January the 30th 2022.


*


The participation 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


PRIVACY
Because of the EU General Data Protection Regulation coming into effect on 25th May 2022 we need to ask for your consent to continue sending you emails with all the latest news about the Course In order to be allowed to keep you on our database after the new data laws come into effect, we just need you to give your authorization