Registration Form 11th Arab Orthodontic Congress 12th Lebanese Orthodontic Congress October 31rst - November 3rd, 2013 at the Mövenpick Resort - Beirut, LEBANON Program and hotel information: www.leborthosoc.com Name: _______________________________________________ First Name:__________________________________________ Preferred Mailing Address:____________________________________________________________________________________ City: _________________________________________________ Country: ____________________________________________ Telephone: (______)__________________ Fax: (______)____________________ Email: ________________________________ FEES 1- Registration Fees (All fees are listed in U.S. dollars, including lunches and coffee-breaks, except lunch on Sunday, November 3rd) BEFORE AUG 15 AFTER AUG 15 LOS, WFO and AOS Member Pre-congress course, Thursday, October 31rst Meeting, Friday, November 1rst - Saturday, November 2nd Post-congress courses, Sunday, November 3rd  $125  $200  $50  $150  $250  $75  $200  $300  $150  $250  $350  $200  $75  $100  $25  $100  $150  $50 Non Member Pre-congress course, Thursday, October 31rst Meeting, Friday, November 1rst - Saturday, November 2nd Post-congress courses, Sunday, November 3rd Students Pre-congress course, Thursday, October 31rst Meeting, Friday, November 1rst - Saturday, November 2nd Post-congress courses, Sunday, November 3rd 2- Gala Dinner, Friday, November 1 rst : Number of guests ____Total number _____x $75 = $ ______________________ TOTAL ENCLOSED: $ ______________________ Cancellations, Changes and Refunds: Fees for missed meals, late arrivals, and early departures will not be refunded. MODE OF PAYMENT 1- By MasterCard  or Visa  please print, complete and send by fax to +9611647435. Card Number:________________/__________________/_________________/__________________ Expiry date:________________________________Security Code:________________________________ Signature:_________________________________ Date:_____________________________________ 2- By Bank transfer in US dollars to: Lebanese Orthodontic Society, IBAN: LB36/0056/0004/1260/7461/0020/3003 - SWIFT: AUDBLBBX Audi Bank, Ashrafieh Branch, Beirut, Lebanon. For alternative mode of payment: Please contact Dr. Chafic Tabbara +9613898313 - Email: [email protected]