ORAL IMPLANTOLOGY
Singapore Programme (9th Intake, 2008)
Application Form
|
CERTIFICATE IN
ORAL IMPLANTOLOGY Singapore Programme (9th Intake, 2008) Application Form |
I am interested in applying for a place in the
Certificate in Oral
Implantology Course Intake 02 beginning July 2008
Certificate in Oral Implantology,
Special Course SC beginning 2008
I am interested in the following area:
Personal Details
Surname / Family name: |
Title: | |
First name / other names: |
Sex: |
Name to appear on Certificate: |
I/C or passport No.: |
Nationality: |
Date of birth (dd/mm/yy): |
Race: |
Correspondence Address
Office Home
| Address: Blk: | |
| Street: | |
| Unit: | |
| City: | |
| Postal Code: | Country: |
Contact Information
| Office Tel. : | Home Tel.: |
| Mobile Tel.: | Fax No.: |
| E-Mail: |
| Web : |
Educational History
| Degree / Qualification: | Institution: | Year received: |
| Preferred Payment Method |
| By cheque / credit card (lump sum payment of S$21,000.00+S$1,470.00 GST) |
| By cheque / credit card (3 monthly installments of S$7,050.00+S$493.50 GST) |
| By cheque / credit card (6 monthly installments of S$3,550.00+S$248.50 GST) |
| current GST at 7% |
Signature: _______________________________ Date: _____________________
| Important: Please enclose certified copies of qualifications and other implant course attendance records. Don't forget to sign and date and mail or fax this form before 31st May, 2008 to: Ms Evelyn Soh Fax - (65) 67321979 Tel - (65) 67343162 Email: (singdent@singnet.com.sg)
|
| Last updated April 2008 |
ã 2000