Bascd & Eadph Joint Conference London 2012

British Association for the European Association for Study of Community Dentistry Dental Public Health 17th Annual Meeting

BASCD & EADPH JOINT CONFERENCE LONDON 2012 Thursday 15th (2pm) – Saturday 17th (12 noon) November Royal Institute of British Architects, Portland Place, W1B 1AD

REGISTRATION FORM

Title Name Address

Postcode Tel. No. Email

EADPH Registration No:- (if applicable) GDC Registration No:- (or other registration number for CPD purposes) (if applicable)

* EARLY BOOKING before 15th Sep 2012 is recommended to avoid £60/€72 late booking fee *

BOOKING OPTIONS:- (£) or (€) – PLEASE STATE CLEARLY IN ‘TOTAL’ BOX

Total £ / € 1. COMPLETE CONFERENCE PACKAGE:- Reception (Thursday 15th), Dinner (Friday 16th) & Lunches & Refreshments

BRITISH £ EURO € Member rate: £320 €396 Non-member rate: £420 €521 Student/Retired rate: £290 €360

2. CONFERENCE DAY PACKAGE (without Reception & Dinner) British Association for the European Association for Study of Community Dentistry Dental Public Health 17th Annual Meeting

Lunches & Refreshments

Member: £210 €260 Non-member: £310 €384 Student/Retired Rate: £190 €236

3. FRIDAY DELEGATE ONLY Lunch & Refreshments

Member: £120 €149 Non-member: £150 €186 Student/Retired: £100 €124

4. CONFERENCE RECEPTION Additional for Day Delegate only £42 €52

5. CONFERENCE DINNER Additional for Day Delegate only £70 €87

NB – If applying after 15th September – please add £60 / €74 - late booking fee

SUB-TOTAL for DELEGATES

ACCOMPANYING PERSON:-

1. CONFERENCE RECEPTION £42 €52

2. CONFERENCE DINNER £70 €87

SUB-TOTAL for ACCOMPANYING PERSON

TOTAL ENCLOSED

PLEASE STATE CLEARLY – (£) or (€) – THANK-YOU

British Association for the European Association for Study of Community Dentistry Dental Public Health 17th Annual Meeting

Special requirements: Please advise of any special dietary or other requirements e.g. mobility, hearing etc

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Payment/confirmation of BACS must accompany the registration form.

I am paying by the following method (please tick one only)

1. Cheque (personal)* 

2. Electronic Payments (personal)* 

3. Cheque (employing organisation)  Please tick if you require an invoice 

4. BACS (employing organisation)  Please tick if you require an invoice 

* preferred payment method

Further guidance on each of these payment methods is outlined below

1. Cheques (personal) Please make cheques payable to BASCD and send together with a completed application.

2a. Electronic Payments (personal) in Sterling Payment can be made in Sterling via internet banking to BASCD sort code 162406, account no. 10223851.

Please ensure that you enter your initials followed by EADPH as the payment reference.

2b. Electronic payment (personal) in Euros Payment can be made in Euros via internet banking to: Account name: British Association for the Study of Community Dentistry Account address: 66 South Mall Cork Sort code: 934178 Account number: 16225027. IBAN: IE12 AIBK 9341 7816 2250 27 BIC: AIBKIE2D British Association for the European Association for Study of Community Dentistry Dental Public Health 17th Annual Meeting

Please ensure that you enter your initials followed by EADPH as the payment reference.

3/4. Cheque/BACS Payments (employing organisation) If your employer will be sending a cheque or BACS payment please enter the name of your employing organisation below and send a COPY of this completed form to secure early registration. The original should come from your employing organisation. If a invoice is required, please indicate this on your registration form. Please specify if you would prefer the invoice to be raised in Sterling or Euros.

Name of Employing Authority/Trust:......

Original forms should accompany cheques or be sent with BACS payment details to: EADPH, C/o VSM Europe Ltd 8 Salmon Fields Business Village Royton Oldham OL2 6HT Tel : 0161 665 2882 Fax : 0161 665 5884 email : [email protected]

SPECIAL INTEREST WORKING GROUPS - THURSDAY 2.45pm PLEASE IDENTIFY YOUR CHOICE OF WORKING GROUP AS BELOW – if not chosen a group will be allocated

PLEASE CHOOSE WHICH GROUP YOU WOULD LIKE TO ATTEND & TICK RELEVANT BOX:- (ONE GROUP ONLY – 1st choice & 2nd choice )

PLEASE TICK PLEASE TICK

1st Choice 2nd Choice British Association for the European Association for Study of Community Dentistry Dental Public Health 17th Annual Meeting

1. Caries Epidemiology and Prevention - Chair: Klaus Pieper

2. Gerodontology - Chairs: Jacques Vanobbergen and Luc Devisschere

3. Periodontal Epidemiology - Chairs: Roos Leroy and Kenneth Eaton

4. Prevention of Oral Cancer - Chair: Katrin Hertrampf

5. Tooth Surface Loss/Erosion - Chair: Carolina Ganss

6. Quality of Life - Chair: George Tsakos

7. Dental Public Health Education - Chair: Jenny Gallagher