Booking Form

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

Registration:			Number
	Dentist	£425
Courchevel  2009 January 17 - 24	Hygienist	£275
	Dental Technician	£275
Names of additional Delegates:	Dental Assistant	£225
		Total:  £

Comments or Special Requirements?

BILLING Site safe and SSL security encryption ensures secure transfer of credit card details or if you prefer fax this form directly to us or phone through your card details. Alternatively payment can be made by cheque or Bankers draft (excluding any bank charges). Credit Card VISA MasterCard Access Delta Switch Cardholder Name Card Number Expiry Date / Deduct the following amount £pounds sterling. 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