CZECH ORTHODONTIC CONGRESS

s
ZNOJMO
9/23 - 9/25 2004

Invitation	4
Programme	4
Abstract	4
Speakers	4
Contact	4
Map	4
Individuals
Information	4
Application	4
Organisations
Information	4
Application	4

Znojmo	4
Photos	4

Application - MS Word document

Application
for Individualis

Surname
Name
Degree
Address: Street
Town
Post code
Country:
Tel.
Fax
E-mail
Accompanying person
Note

Participants charges	Pald until 30. 6. 2004	Pald from 1. 7. 2004
ČOS, EOS, WFO members	9 900,- CZK	11 000,- CZK
ČOS members- special. preparetion at a clinic*	4 000,- CZK	5 000,- CZK
ČOS, EOS, WFO non-members	9 900,- CZK	11 000,- CZK
Accompanying person (opening ceremoiny and evening social events)	2 500,- CZK	3 000,- CZK

* ČOS members - doctors who are in specialized preparation in orthodoncy and who are full time working in dental clinics (enclose a certification from headmaster of orthodontic clinic) or orthodontic specialist who work full time in orthodontic clinic where they have at least three orthodontic training seats for orthodontic specialists (enclose statutory declaration).

I promissory apply to participate the ČOS congress and I send the amount
by bank transfer to bank account of ČOS, account number.: 19 - 15 60 32 93 19 / 0800.
IBAN: CZ24 0800 0000 1915 6032 9319
BIC: GIBACZPX
I use my passport number as the variable symbol: .