Asia-Pacific Dental Forum Flyer & Registration Form
Asia-Pacific Dental Forum Flyer & Registration Form
Asia-Pacific Dental Forum Flyer & Registration Form
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
REGISTRATION DETAILS<br />
DENTIST NAME: ____________________________________ INVOICE NAME: ____________________________________________<br />
GUEST/SPOUSE NAME: ______________________________ SURGERY EMAIL: ____________________________________________<br />
SURGERY ADDRESS: _____________________________________________________________________________________________<br />
____________________________________________________________________________________POSTCODE __________________<br />
SURGERY PHONE: (_____)_____________________________ MOBILE: ___________________________________________________<br />
◊ PLEASE LIST ANY SPECIAL DIETARY REQUIREMENTS ___________________________________________________________________<br />
Full APDF Package: $2999.00<br />
Includes: Educational package (3 days of APDF lectures) , 5 nights double room accommodation, breakfast daily for 2 people,<br />
welcome cocktail event, white on white dinner and charity auction, dessert and champagne farewell event.<br />
Events and Educational Package only: $1599.00<br />
Includes: Welcome cocktail event, white on white dinner and charity auction, dessert and champagne farewell event.<br />
Educational Package only, 3 days of APDF lectures, morning tea and buffet lunch.<br />
Educational Package only: $999.00<br />
Includes: Educational Package only, 3 days of APDF lectures, morning tea and buffet lunch.<br />
Rewards Credit Claim: $500 $1000 $2000<br />
◊ ‘Rewards Credit Claim’ terms and conditions:<br />
Rewards points will be deducted according to your status as of June 30, 2012. Please check your VPS site for your status.<br />
CANCELLATION POLICY: Full costs will be charged if package is cancelled after October 16, 2012.<br />
PAYMENT DETAILS<br />
◊ Please charge my SCDL Account: SCDL Account number: _____________________________________<br />
◊ Cheque enclosed (Please make payable to SOUTHERN CROSS DENTAL LABORATORIES)<br />
◊ Please charge my: VISA DINERS MASTERCARD AMEX (incurs a 2% surcharge)<br />
Card No. Expiry _____/_____CVC ____<br />
Signature ___________________________________ Cardholder name ______________________________<br />
Additional Options.......<br />
James Bond Island Cruise: $70.00 PER ADULT GUEST/S ATTENDING: ___________________________________________________<br />
Includes: Speed boat journey, land transfers, national park fees, English speaking guide, Thai lunch on Panyee Island, non-alcoholic beverages<br />
Blue Canyon Golf Day: $199.00 PER PERSON GUEST/S ATTENDING: __________________________________________________________<br />
Includes: A morning game of golf, club hire and return transfers from the JW Marriott to the Blue Canyon Country Club<br />
Ginja Cooking School: $85.00 PER PERSON GUEST/S ATTENDING: ____________________________________________________________<br />
Includes: An afternoon Ginja Cooking Course, preparing, cooking and eating Thai dishes under the guidance of an experienced Thai chef<br />
All APDF ‘Additional Options’ during the event and ‘Accommodation’, pre,<br />
during and post the event MUST be booked via Natalie by email: natalieg@scdlab.com<br />
RETURN TO:<br />
FAX TO: (02) 9362-1199 ◊ CONTACT SCDL EVENTS : (02) 9362-1177<br />
EMAIL: events@scdlab.com ◊ MAIL TO: PO BOX 607, DOUBLE BAY, NSW 1360<br />
The <strong>Asia</strong> <strong>Pacific</strong> <strong>Dental</strong> <strong>Forum</strong> qualifies for 9 CPD points.
Change language