REGISTRATION FORM
8th Congress of ICOI/AP & 20th AOIA Symposium, Aug 27-31 2004, Singapore
Please type or print in block letters, check the appropriate boxes and return to the Secretariat
Title Surname Other names
Address
Country Postal Code
Phone Fax Email
Name of Accompanying Person
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A. |
Registration fees for all sessions on 28 & 29th August, 2004 | |||||
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√ |
Please tick |
{ } Before 30/6/04 |
{ } After 1/7/04 |
1. Fees are in Singapore dollars, inclusive of prevailing 5% GST at the time of congress.
2. Membership in sponsoring and co-sponsoring organisations entitled to discount of 10%
3. The registration fee includes a congress banquet, light luncheons and coffee breaks on Aug 28 & 29 only.
4. Accompanying person’s fee includes congress banquet and social programmes.
5. US$1=S$1.7 approximately in April 2004 | ||
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{ } |
Dentist |
$420.00 |
$504.00 | |||
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{ } |
Graduate Student |
$273.00 |
$336.00 | |||
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{ } |
Dental Student |
$210.00 |
$252.00 | |||
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{ } |
Auxiliary /Technician |
$210.00 |
$252.00 | |||
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{ } |
Accompanying Person |
$126.00 |
$126.00 | |||
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B. |
Pre Congress courses on 27th August, 2004 | |||||
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{ } |
Dr Caesar Wong (1): 9.00am-11.30am |
$84.00 | ||||
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Dr Caesar Wong (2): 11.30pm-2.00pm |
$84.00 | ||||
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{ } |
Dr Vincent Morgan: 2.30pm-4.30pm |
$63.00 | ||||
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{ } |
Prof G-H Nentwig & Dr Paul Weigl: 5pm-7.30pm |
$84.00 | ||||
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{ } |
Dr Michael Danesh-Meyer: 8.00pm-10.30pm |
$84.00 | ||||
| C. | Laser Workshop on 29th August, 2004 | |||||
| { } | Dr John Chen & Dr Ben Ong: 6.00pm-8.00pm |
$63.00 | ||||
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D. |
Post Congress courses on 30th & 31st August, 2004 |
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{ } |
Please send me more information on: Advanced implant and cadveric course by Dr Robert London (organised by Singapore Dental Association and Asia Implant Support Services)+ |
+By separate application and registration
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Total amount A+B+C
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S$ ___________________________________ |
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Less discount 10% (if applicable)
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S$ ___________________________________ |
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Enclosed payment of fee
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S$ ___________________________________ |
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{ } by cheque/bank draft No. ___________________________________
Payable to Orchard Dental Centre Pte Ltd
{ } by credit card
{ } Visa { } Mastercard { } American Express
Card No. _____________________________________________ Expiry Date _________________
Signature _______________________________ Date ___________________________________
Congress Hotel Booking
8th Congress of ICOI/AP & 20th AOIA Symposium, Aug 27-31 2004, Singapore
Please type or print in block letters, check the appropriate boxes and return to the Secretariat
Name of Person Sharing room (if applicable)
I require hotel booking at The New Otani for _______ nights,
check in on ______________________and check out on _______________________.
Please charge the one room night deposit of
{ } S$130+++ (single)
{ } S$145+++ (double/twin)
- all rates inclusive of breakfast
to my credit card
{ } Visa { } Mastercard { } American Express { } others (specify)____________________
Card No. ____________________________________________ Expiry Date __________________
Signature _______________________________ Date ___________________________________
Corresponding address:
The ICOI/AP-AOIA Meeting Secretariat
c/o Orchard Dental Centre Pte Ltd
268 Orchard Road #05-07
Singapore 238856
Tel : 65 6734 3162
Fax: 65 6732 1979
Email: singdent@singnet.com.sg
Website: http://web.singnet.com.sg/~qualiser/meeting.html