Registration



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International Association for Dental Research (IADR)

Pulp Biology Regeneration Group (PBRG) Symposium 2016

26th-28th June 2016, Nagoya, Japan



REGISTRATION
  c:\データ\2016pbrg\iadr rogo\もらったもの\iadr_pulpbiopms287.jpg


RETURN TO

IADR_PBRG2016 Secretariat

c/o Inter Group Corp.

Orchid Building 8F, 2-38-2, Meieki, Nakamura-ku, Nagoya, 450-0002 JAPAN

Email iadr_pbrg2016@intergroup.co.jp



REGISTRATION DEADLINE:June 15, 2016



REGISTRATION INSTRUCTIONS



  1. This form must be completed for each registrant.

  2. The symposium fees include; registration, symposium, banquet, coffee break, lunch break and abstract book.

  3. Please transfer ¥36,000/ person to the following bank account.

 


Will you attend the welcome reception (first day)?    □ No  or Yes (+5,000)


BABK ACCOUNT INFORMATIOM



Beneficiary Bank

THE BANK OF TOKYO-MITSUBISHI UFJ, LTD.

SWIFT code / BIC code

BOTKJPJT (8 digits)

BOTKJPJTXXX (11 digits)

Branch Name

OBU BRANCH

Beneficiary Account Number

344-0163483

Beneficiary Name

IADR PBRG SYMPOSIUM JIKKOIINKAI NAKASHIMA MISAKO

Bank Adress

3-59,CHUO-CHO,OBU-CITY,AICHI,JAPAN



Cancellation policy


This event will not be eligible for a refund.

REGISTRANT INFORMATION
First Name and Middle Initials (only your first name will appear on badge)

Last/ Family Name (as it will appear on badge)



Company/Institution Department Street Address 1 Street Address 2

State/Province

Country

Postal Code



Telephone Fax Email Emergency Contact’s Full Name Emergency Contact’s Telephone Number






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