Register Information

Name

Phone

Email

REGISTRATION FEE

JUNE 25th Pre-Symposium (BCE)

JUNE 25th Symposium (BCE)

NON MEMBER

D $400

D $500

ICOI &AAID

MEMBER

D $250

D $300

IC: I International Congress of Oral lmplantologists

Courses are applicable to ICOI advanced credentials

As an AGD PACE provider course, the educational credits at this conference may be

used toward the educational requirement for the American Academy of Implant

Dentistry (AAID) credentials

Cancellation policy Cancellation request made 4 weeks prior to the course start date will receive a full refund. Cancellation request made 2 weeks prior to the course start date will receive half of total course fee. Cancellation request made less than 2 weeks prior to the course start date will not receive any refund. Cancellation will be received via phone, email or fax, and it has to be received by the stated deadline.

Payment Information

Payment Type o Check o Card

* Payable to Neobiotech USA

Card Type D VISA D Master D Amex

Card Number

Exp.Date

cw

Billing Address

PACE PNF-�.,,., <-•..., t4-at._

Tel: 415-496-9636 (415-49MyNeo) Fax: 916-915-1212

Global Academy of Osseointegration is designated as an Approved PACE Program Provider by

the Academy of General Dentistry. The formal continuing education programs of this program

provider are accepted by AGD for Fellowship, Mastership and membership maintenance

credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD

endorsement. The current term of approval extends from 11/1/2014 to 10/31/2016. Provider

ID# 360859