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Title

First Name

Surname

Street

Postal Code / City

Country

Nationality

Tel. Office

Tel. Home

Fax

Mobile Phone

Email

Dentist

Oral Surgeon

Maxillofacial Surgeon

Other Speciality

Graduated from (Name of University)

Spoken Languages

Experience with Implantology

I am a member of DGZI

I am submitting my binding application concerning the participation In the mentioned education In Oral Implantology I am aware that there are additional fees to be paid for clinical cases of the training program and that neither the cost of

Implants and prosthesis nor the Internship or supervision costs are Included In the course fee.

The legal contractual regulation detailed In the program brochure became the basis of this application and as such are an integral part of the contract with regard to course topics. The issues detailed in the program brochure are considered as agreed between the concerned parties. However it must be  again that changes and amendments beyond the scope shown there it can be made at the sole discretion of the organizers.

 

I will submit my examination qualification in English translation to the board of directors.

Signature (name)

Date

FEES

Curriculum Implantology (5600 Euros incl. 8 weekend sessions)

Internship (100 Euros per case)

Supervision (200 Euros per implant)

 

Note : Acceptance in the program is subjected to the board of directors decision

and after submitting all required documents and the payment of 700 Euros

Non-refundable with application (Application fees of the GBOI are part of tuition)

 

 

 

PAYMENT METHODS:

** 50 % of the fees before the 1st session

** 25% of the fees before the 4th session

** 25% of the fees before the 7th session