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Mail: info@vet-implantate.de

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Please fill out our registration form as completely as possible. The fields marked with * are mandatory.

Registration to event*

Employer / hospital / medical practices*
Street*
Postcode / City*
Phone number*
Email*

Attendance*	alone accompanied by name:
I will arrive at ###DATE_FIRST### and will stay*	1 night 2 nights
I will arrive at ###DATE_LAST### and will stay*	1 night without overnight stay
I do not need any overnight stay	no overnight stay opportunities
I will take the shuttle bus ###SHUTTLEBUS### and back*	yes no
Attendance to the dinner ###DINNER###*	yes yes, with companionship no

	In submitting this application, I recognize the financial contribution towards costs. I will pay the entire course fee immediate into the stated bank account of Königsee Implantate. After registering your payment, I will receive an enrollment confirmation.