PLEASE ENSURE THAT YOU WRITE THE CORRECT SPELLING OF YOUR NAME, THE SAME AS THE ONE WRITTEN IN YOUR PASSPORT.
* Required
Title:
Mr.
Mrs.
Ms.
Dr.
Prof.
Gender:
Male
Female
*
Name of Event:
*
Type your Complete Name:
( The NAME you type here is the name that appears in the Certificate. )
*
Hospital/Clinic:
Division/Department:
*
Position/Title:
*
Degree:
P.O. Box:
*
Nationality:
City:
City Code:
Fax #:
City Address:
*
Your Email Address:
*
Mobile #:
Telephone #:
Please attached the following Requirements:
- Copy of your Saudi Council License ID
- Copy of your Passport (page with your Complete Name.)
- Copy of your Basic Implant Training Program Certificate
Registration Fee is not Refundable
Early Registration Fee: SR 11,000
Late Registration Fee: SR 12,000
Early Registration On or Before: April 10, 2013
PAYMENT INFORMATION:
*
Payment Type:
Cheque
Cash
Transfer Bank Account
- Please attach the Copy of your Bank Receipt.
Registration must be accompanied by payment. Please make your Bank Drafts / Check payable to:
Bank Name:
SAMBA Bank
Account Name:
Riyadh Colleges of Dentistry & Pharmacy
IBAN No.:
SA 604 000 000 000 2600 956 450
* Registration becomes valid only upon Payment of Registration Fees.