Nobel Biocare

egistration: world tour Montreal november 2–4The preferred way of registering to the World Tour is through our website, www.nobelbiocare.com/worldtour.By registering online you get real time information and instant confirmation of your participation.general informationFirst name:Last name:Title: Prof Dr Mr Mrs Ms MissCompany name:Address type: Business HomePO Box:Street address:Postal code:Country:Telephone:Mobile:City:Confirmation of registration and updates will be sent bye-mail only so please provide your e-mail address.E-mail:Fax:Preferred language of communication:How would you like to hear from us? (check only one)E-mail Post Fax TelephoneAre you a Nobel Biocare customer?No Yes If Yes, Customer number (optional):Comments:Registration Profession: (check only one)GP – RestorativeGP – Restorative & SurgerySpecialist – Oral surgeonSpecialist – ProsthodontistSpecialist – PeriodontistSpecialist – EndodontistAdministrator/StaffLaboratory OwnerLaboratory TechnicianUnder Graduate StudentPost Graduate StudentInvestorPressOther (Please specify):Type of practice: (check only one)SurgicalSurgical & ProstheticsGeneral/RestorativeProstheticsLaboratoryOther (Please specify):Type of business: (check only one)Private Practice Public Dental Care FacultyMilitaryNot applicableconference feesFull conference option:Registration fee includes admission to the conference workshop andhands-on program, general program and focus sessions, lunches andbreak refreshments over three days.Up to Sept 15th After Sept 15thDentist $645 CAD $745 CADDenturist: $445 CAD $545 CADLab Personnel: $245 CAD $345 CADAuxiliary/students/other: $99 CAD $99 CADOne-day tickets:If you cannot attend all three days you can also buy one-day tickets.$299 CAD $299 CADPrice calculation ($ CAD):Conference fees $ ___________ Party $ _________Childcare $_________GRAND TOTAL $The preferred way of registering to the World Tour is throughour website, www.nobelbiocare.com/worldtourmethods of payment: (check only one)Pay by credit cardI give authorization for the use of my credit card for allcharges relating to tuition costs for the Nobel BiocareWorld Tour Montreal, November 2–4, 2006.Card Type: Visa American Express Master CardCard number:CCV-code:Card holder name:Card expiry date: /Invoiced by Nobel Biocare Canada(If different from above)Invoice address:Company name:Street address:Postal Code: City:Country:VAT registration number:agreementPlease sign and confirm your acceptance of our cancellationpolicy and your registration informationSignature:(Look at the back of the card)party friday november 3(includes drinks, food, entertainment and dancing)I will be attending – $125 CADI will bring _____ more guests($125 CAD/per person – max. 4 guests)Date: / /return the registration form to:9133 Leslie StreetUnit 100Richmond Hill, OntarioL4B 4N1Tel: 1-800-939-9394Fax: 1-800-900-4243