International Association for Dental Research (IADR)
Pulp Biology Regeneration Group (PBRG) Symposium 2016
26th-28th June 2016, Nagoya, Japan
c/o Inter Group Corp.
Orchid Building 8F, 2-38-2, Meieki, Nakamura-ku, Nagoya, 450-0002 JAPAN
REGISTRATION DEADLINE：June 15, 2016
This form must be completed for each registrant.
The symposium fees include; registration, symposium, banquet, coffee break, lunch break and abstract book.
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
This event will not be eligible for a refund.
First Name and Middle Initials (only your first name will appear on badge)
Last/ Family Name (as it will appear on badge)
Street Address 1
Street Address 2
Emergency Contact’s Full Name
Emergency Contact’s Telephone Number