Course Registration of Triple O Dental Lab

Registration Form

Course II - Straightwire Therapy
June 15th - 17th 2012 - London, U.K.

Title

* First Name / Initials

* Last Name

* Practice Address

* Town / City

* Postcode

* Country

Other Country or
Info Box

* Daytime Telephone

Fax

* Email

* GDC Registration Number

* Please select your registration options.

The cost of the seminar includes course notes, refreshments and lunch.

Actual Date /Time:

Please fill in your data into all Fields with a *.
They are necessary for the Registration

Our registration terms & conditions are as follows:

Full payment will be required when booking

Triple O reserve the right to change the advertised seminar programme / dates due to any unforeseen circumstances beyond our control.

We accept MasterCard, Visa, Switch and American Express.

If you do not wish to send your Credit Card details through the Internet,
please leave this section Blank and you will be contacted
for your details.

Start Date Exp Date

For Switch / Maestro payments enter the issue number here:

Important ! Security No (The last three numbers on the back of the card)

Please reserve me a room at the Sheraton Heathrow Hotel at the sp

A delegate rate of £105.00 on Thursday night and £75.00 on Friday and Saturday at the Sheraton Heathrow Hotel, London has been arranged.
To get special rate you must book through CFOO. If you are booking Thursday night, your credit card details will be given to the hotel to confirm the booking.
If you would like to reserve one of these rooms please use this online reservation as availability is limited.

Please reserve me a room at the Sheraton Heathrow Hotel at the special delegate rate of £75.00 Friday and Saturday per night (Thursday night is £105.00) for:

Thursday night Friday night Saturday night

I understand the hotel will expect payment on departure for all accommodation charges.

Registration Form

Course II - Straightwire Therapy June 15th - 17th 2012 - London, U.K.

Select Registration Options First Attendance -- £795.00 Repeat Attendance -- £395.00 Auxilliary Attendance -- £395.00

The cost of the seminar includes course notes, refreshments and lunch.

Actual Date /Time:

Please fill in your data into all Fields with a *.They are necessary for the Registration

Please reserve me a room at the Sheraton Heathrow Hotel at the sp

Please reserve me a room at the Sheraton Heathrow Hotel at the special delegate rate of £75.00 Friday and Saturday per night (Thursday night is £105.00) for:

Thursday night Friday night Saturday night

Course II - Straightwire Therapy
June 15th - 17th 2012 - London, U.K.

Please fill in your data into all Fields with a *.
They are necessary for the Registration