Booking Form

Please provide the following Booking information:

First Name
Last Name
Title
Street Address
Address (cont.)
City
Zip/Postal Code
Country
Telephone
FAX
E-mail

Registration:			Number
	Dentist	£500
Courchevel  2019 March 17-23	Hygienist	£280
	Dental Technician	£280
Names of additional Delegates:	Dental Assistant	£230
		Total:  £

Comments or Special Requirements?

BILLING Payment can be made by Direct Transfer, cheque or Bankers draft (excluding any bank charges) Made payable International Dental Foundation. Bank Details   International Dental Foundation   Sort Code: 20-06-13   Account: 00490032   SwiftBic: BARCGB22     IBAN: GB97 BARC 2006 1300 4900 32 I confirm that I would like to register for the conference and  am responsible for arranging appropriate travel insurance.   Print and fax or post to                                 IDF, 53 Sloane Street,London,SW1X9SW             Fax: 00 44 (0) 20 7235 0767