International Association for Dental Research South East Asian Division

22nd Annual Scientific Meeting

South – East Asia Association for Dental Education

19th Annual Meeting

MANILA, PHILIPPINES

October 8 – 10, 2008

PRE- REGISTRATION FORM

IADR member: □ Yes □ No
IADR ID # Division:
Are you are Presenter? □ Yes □ No Abstract ID #
Participant: □ Prof □ Dr □ Mr. □ Mrs. □ Ms Gender: □ Male □ Female
Family Name: First Name:
Mailing Address:
City: Country: Postal Code:
Telephone: Fax: E-mail address:
Accompanying person
Family Name: First name: Gender:
Family Name: First name: Gender:
Family Name: First name: Gender:

REGISTRATION FEE (In US Dollars)

With accommodation ( October 7 – 9, 2008 or October 8-10, 2008) /

Amount

Triple Sharing / Twin/Double Sharing / Single
Until
Aug 20, 2008 / After
Aug 20, 2008 / Until
Aug 20, 2008 / After
Aug 20, 2008 / Until
Aug 20, 2008 / After
Aug 20, 2008
IADR Member / 300 / 350 / 350 / 400 / 450 / 500
Non IADR Member / 350 / 400 / 400 / 500 / 500 / 600
Student / 225 / 275 / 275 / 325 / 375 / 425
Accompanying person to share room with participant – USD 170/person
Registration Rate without accommodations – USD 225
Total =
On-site registration / Member / Non Member / Student
Triple / 555 / 650 / 500
Double / 455 / 550 / 400
Single / 405 / 450 / 350

Extra Room Rate (Before or after the meeting) – USD95/night

Additional charge of USD 30 per person for airport transfer to and from the hotel.

Note: Accommodations will be at Manila Hotel

Date of Check-in: ( ) October 7, 2007 ( ) October 8, 2008

I have arranged a triple/twin sharing accommodation with another participants, whose name is,

Prof/Dr/Mr/Mrs/Ms______

* A separate registration form must be accomplished by each participant, except for accompanying person.

*For triple / twin sharing accommodation, please send registration forms of the three / two participants together if personal arrangement has been made.

The registration fee for members, non-members and students are inclusive of:

·  attendance in all sessions

·  admission to the exhibition

·  3 nights accommodation with breakfast at Manila Hotel

·  3 lunch, 6 snacks , 1 gala dinner

For accompanying person, registration fees include:

·  admission to exhibition

·  3 breakfasts, 3 lunch , 1 gala dinner

Payment Information

All payments must be made in US Dollars

□ Pay through bank

Deposit to Account # 0341 – 022501 - 200

Account name : CEU College of Dentistry

Name of Bank: Security Bank – Mendiola Branch

Amount: ______

□ Pay by credit card.

Charge to □ Visa □ Master card Amount:______US Dollars

Card Number: ______

Card Holder’s Name ______

Expiry Date :______

Card No. ______

( last three digit number at the back of the card)

Card Holder’s Signature______Date ______

Note: The IADR SEAADE MANILA LOC 2008 reserves the right to charge the correct amount if different from the total payment
Cancellation Policy

Written cancellation received before 30th of August 2008 will be entitled to a full refund less USD 50 processing fee. No refund will be made for cancellation received thereafter.

Please mail this form together with payment to:

The Secretariat, IADR SEAADE MANILA 2008

c/o Dr. Pearly P. Lim

Centro Escolar University

School of Dentistry

9 Mendiola Street, San Miguel

Manila, Philippines 1005

E-mail:

You may fax your registration form with credit card payment.

Do not send the form by mail if you have registered by fax or email to avoid duplication.

Fax: +632 – 7342073

logo / International Association for Dental Research South East Asian Division
22nd Annual Scientific Meeting

South – East Asia Association for Dental Education

19th Annual Meeting
MANILA, PHILIPPINES

October 8 – 10, 2008

PRE-REGISTRATION FORM