REGISTRATION FORM FOR 3 YEAR ORTHODONTIC MINI … · REGISTRATION FORM FOR 3 YEAR ORTHODONTIC MINI...
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Excellence in Orthodontics and Dentofacial Orthopeadics P.O. Box 6151 UNSW Sydney, NSW 1466 Sydney, Australia Ph: +61 2 9398 8338 E-mail: [email protected] www.eodo.com REGISTRATION FORM FOR 3 YEAR ORTHODONTIC MINI RESIDENCY PROGRAMME 2017 - 2019 SURNAME: ____ FIRST NAME: ADDRESS: CITY: STATE: POSTCODE: COUNTRY: PHONE: EMAIL: How did you hear about our course? - Colleague Alumni Internet Advert (please specify name of Magazine) ___________________ Other ___________ PAYMENT METHOD VISA MASTERCARD BANKCARD AMEX NAME ON CARD: CARD NO. EXPIRY DATE: CCV. NO. OR - I HAVE ENCLOSED A CHEQUE MADE PAYABLE TO EODO FOR THE AMOUNT OF $ . PAYMENT / FEES All courses require a 50% Deposit to hold your place. Per course: AUD $2,500.00 (incl GST) - Includes Theory & Clinical session (3 days in total) Pay for 1 year upfront to receive 5% discount. Pay for 2 years upfront and receive 10% discount Pay for 3 years upfront and receive 15% discount CANCELLATION POLICY All cancellations must be made, in writing via email, to [email protected] . Where no written notice of cancellation is given, or a failure to attend the course, there will be no refund issued. For all cancellations, an administration fee of $100 will be charged. Cancellations made 4 weeks prior to the course start date are refunded in full.* Cancellations made within 2-4 weeks of the course start date will be refunded to 50 percent.* Cancellations made within 1-2 weeks of the course start date have an option of a 25 percent credit on the account, to be used for future courses, but there is no refund.* * If the original payment was made by credit card, the credit card transaction fee cannot be refunded. Please send this form back to EODO via email ([email protected] ), fax (02 9314 5936) or post (P.O. 6151, UNSW Sydney NSW 1466)
Transcript of REGISTRATION FORM FOR 3 YEAR ORTHODONTIC MINI … · REGISTRATION FORM FOR 3 YEAR ORTHODONTIC MINI...
Excellence in Orthodontics and Dentofacial Orthopeadics
P.O.Box6151UNSWSydney,NSW1466Sydney,AustraliaPh:+61293988338E-mail:[email protected]
REGISTRATIONFORMFOR3YEARORTHODONTICMINIRESIDENCYPROGRAMME2017-2019
SURNAME: ____ FIRSTNAME:
ADDRESS:
CITY: STATE: POSTCODE:
COUNTRY: PHONE:
EMAIL:
Howdidyouhearaboutourcourse?-Colleague AlumniInternet
Advert(pleasespecifynameofMagazine)___________________Other___________
PAYMENTMETHOD
VISA MASTERCARD BANKCARD AMEX
NAMEONCARD:
CARDNO.
EXPIRYDATE: CCV.NO.
OR-IHAVEENCLOSEDACHEQUEMADEPAYABLETOEODOFORTHEAMOUNTOF$ .
PAYMENT/FEESAllcoursesrequirea50%Deposittoholdyourplace.Percourse:AUD$2,500.00(inclGST)-IncludesTheory&Clinicalsession(3daysintotal)Payfor1yearupfronttoreceive5%discount.Payfor2yearsupfrontandreceive10%discountPayfor3yearsupfrontandreceive15%discountCANCELLATIONPOLICYAllcancellationsmustbemade,inwritingviaemail,[email protected],orafailuretoattendthecourse,therewillbenorefundissued.Forallcancellations,anadministrationfeeof$100willbecharged.Cancellationsmade4weekspriortothecoursestartdatearerefundedinfull.*Cancellationsmadewithin2-4weeksofthecoursestartdatewillberefundedto50percent.*Cancellationsmadewithin1-2weeksofthecoursestartdatehaveanoptionofa25percentcreditontheaccount,tobeusedforfuturecourses,butthereisnorefund.**Iftheoriginalpaymentwasmadebycreditcard,thecreditcardtransactionfeecannotberefunded.
PleasesendthisformbacktoEODOviaemail([email protected]),fax(0293145936)orpost(P.O.6151,UNSWSydneyNSW1466)
Excellence in Orthodontics and Dentofacial Orthopeadics
P.O.Box6151UNSWSydney,NSW1466Sydney,AustraliaPh:+61293988338E-mail:[email protected]
REGISTRATIONFORMFOR3YEARORTHODONTICMINIRESIDENCYPROGRAMME2017-2019
2017
CourseI 18-19 March 2017
OrthodonticDiagnosis
CourseII 6-7 May 2017 Orthodontic Treatment Planning and Cephalometrics
CourseIII 15-16 July 2017 Mixed Dentition Treatment and Myofunctional Therapy
CourseIV 16-17 September 2017 ClassIICorrection
CourseV 28-29 October 2017 ClassIIICorrection
CourseVI 9-10 December 2017 StraightwireMechanicsandPSLTechniques
2018 CourseVII 10-11 February 2018 HighAngleMalocclusions
CourseVIII 14-15 April 2018 Perio/OrthoInterface
CourseIX 2-3 June 2018 OrthodonticBiomechanics
CourseX 11-12 August 2018 Surgical Orthodontics/Skeletal Anchorage/ENT
CourseXI 13-14 October 2018 LingualAppliances
CourseXII 24-25 November 2018 ManagementofTMD/Bruxism
2019 CourseXIII 16-17 February 2019 Digital Smile Design/CosmeticInjectables
CourseXIV 6-7 April 2019 Accelerated Orthodontics
CourseXV 1-2 June 2019 Clear AlignersandCombinationTreatment
CourseXVI 10-11 August 2019 The Orthodontic/Restorative Interface
CourseXVII 12-13 October 2019 Advanced Biomechanics
CourseXVIII 1-2 December 2019 Case Finishing and Retention
**NOTE**:ALLDATESARESUBJECTTOCHANGE.Duringthecourse,therecouldbesomechangestothevenueforclinicalday.Shouldthishappen,youwillbenotifiedviaemail,wellinadvance,regardingthevenue/datechange.
Pleasetickonetospecifywhichclinicaldayyouwouldprefertoattend.Pleasenotetherearelimitedspacesavailableforeachclinicaldayoncespacesarefull,wewillnotbeabletoaccommodateyourchoice.
Thursday Friday Monday Tuesdays
Pleasenoteonceyouhavemadeyourchoiceyouwillnotbeallowedtochangeyourdayunlessyouareabletofindsomeonetoswapyourdaywith.
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