Registration

Application Form Q-Implant Marathon Santo Domingo

Santo Domingo
June 12-16, 2017
September 11-15, 2017
December 4-8, 2017
Cambodia
June 5-9, 2017
August 14-18, 2017
Laos
May 8-12, 2017


I learned about this course by:
Lecture
I am a previous attend
Other
 
Mailing
E-mail
 
Colleague
Website


My specialty is:
Oral Surgeon
Prosthodontist
 
Periodonlist
Endodontist
 
General Practitioner
Other


I would like to participate in the following level:
Beginner
Advanced I
Advanced II


First Name *
Last Name *
Address
City
Telephone
Zip code
FAX
Email *
Mobile No
T Shirt Size
S
M
L
XL
XXL

Require Filds *



I bindingly confirm my registration for the Q-Implant Marathon:

The course tuition is $13,950 and includes hotel, meals and local transfers.

Please call (877) 705-1002 or E-mail info@implantologycourses.com for Payment Terms and Financing Options

Guaranteed quantity of implants for Beginner course: 30; Guaranteed operations for Advanced levels: 5 x sinus lift;
All local transfers included; Implants, surgical and prosthetic materials included; Hotel accommodation (single room with bathroom, full pension),
4*-5* local category;

Please make a payment to OPTIMUM SOLUTION GROUP
845 S MAIN ST
SUITE 306
LOMBARD IL 60148 Tel 630-705-1002

Credit card payments Please Call 877-705-1002

The registration is only valid when a deposit is received.