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])
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