Registration form 1 Year Training Program in Oral Implantology 2012 " 10 Session Course in Islamabad"



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REGISTRATION FORM
1 Year Training Program in Oral Implantology 2012

10 Session Course in Islamabad”

Name: _________________________________________________________________________________


Age: _________ Qualification: _____________________________________________________________
Office Address: __________________________________________________________________________
Home Address: __________________________________________________________________________
City: ____________________ Post Code: ________________ Office Tel: ___________________________
Home Tel: __________________________Fax ________________ E-mail: __________________________
Mobile: _______________________ Web add: _______________________­­­­­­­­­­­­­­_____________________

Fee for the complete course: Rs 1, 50,000/- only
The convenient 6 installments payment plan

The 1st Installment: Feb 16: Rs: 25,000

The 2nd Installment: Mar 16: Rs: 25,000

The 3rd Installment: Apr 13: Rs: 25,000

The 4th Installment: May 11: Rs: 25,000

The 5th Installment: June 15: Rs: 25,000

The Final Installment: Jul 13: Rs : 25000
2 day Individual Session: Rs 30,000/ session.
Registration fee enclosed

N.B:

Cheques/Bank Drafts must be made payable to Pakistan Academy of Implant Dentistry.

Please fill in this Registration form and mail via courier to:

The Course Secretary , Pakistan Academy of Implant Dentistry

The Qureshi Dental Centre, 1051-B, LMQ Road , Multan -60700
E-mail: implant_courses@yahoo.com

Face book page: Pakistan Academy of Implant Dentistry

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Strictly limited attendance course.

Please note that it is important to pay the dues before the registration dead line of Feb 16, 2012

IN ORDER TO SECURE YOUR SEAT.

For further information contact:
Course secretary Dr Sara Mateen: 0300 7340020, 0342 9541923




The Centres of Implant & Reconstructive Surgery
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