<p> Registration Form</p><p>Participants (please use Block letters) Surname Female: Male: First name: Title (Dr., Prof., etc…): Institution: Address: Town: Postal Code: Country / State: Telephone: Fax: E-mail: REGISTRATION FEE (in Euros)* Before March 31st, 2008 After March 31st, 2008 Delegate € 680  € 750  Accompanying Guests No: € 600  € 650  Children 6-15 years of age No: € 300  € 350   *Basic registration fee that covers all events and scientific program during the Meeting. Please let us Know the names of yours accompanying guests or children Title First Name Last Name Female Male 1. 2. 3. 4.</p><p> Optional transportation by Metro for delegates & guests to the “Dyonisus” restaurant on Thursday June 12 th 2008 </p><p>Optional Activities for Accompanying Guests / Friday-June,13 2008 Both options are included in the registration fee for accompanying guests. </p><p> 1 st option: Tour for accompanying guests to Acropolis and Plaka (Lunch at a traditional Greek Taverna in Plaka)  2 nd option: spend the day swimming at the beach of Aegeon Hotel in Cape Sounion and join the rest of the group in the evening (Lunch at the restaurant on the beach) </p><p>Optional Extra Activities Pre Congress Golf Tournament, June 11, 2008 This tournament is offered to all the delegates and the accompanying guests Rate per person: € 100 (including transportation and lunch, not including equipment rental).  Rate per person for equipment rental/optional: € 20 Please complete the special Golf Registration form. Number of persons: ______Post Congress Cruise to the Saronic Islands of Aegina and Hydra, June 15, 2008 This cruise is offered to all the delegates and the accompanying guests Rate per person: €100 (including welcome coffee, lunch and happy hour full open bar), per child € 50. Number of adults: ______, Number of children:______</p><p>Grand Total: €______Cancellations & Refunds All cancellations must be made in writing and are in effect 24 hours after the date that they will reach our office. For all notifications of cancellation, please make a reference to a bank account, including the Swift Code, where a possible refund may be remitted less bank charges. In the event that a cancellation is requested, the cancellation fee will be charged according to the following schedule:</p><p>DATES PRIOR TO ARRIVAL CANCELLATION FEE Before April 30th 0% of total price Between May 1st - 31st 30% of total price Between June 1st - 11th 50% of total price No Show 100% of total price Please note that all refunds will only be processed after the completion of the conference.</p><p> I fully understand, agree, and accept the above conditions and charges. (Your registration will not be accepted or confirmed if you do not check this box)</p><p>______Please print/write clearly your full name Signature</p><p>Payment - Full payment must be made generally immediately for your requested services. - Upon receipt of full payment, you will receive confirmation of your reservation via e-mail.</p><p>Total amount to charge in Euro €______</p><p>Payment Type  Bank Transfer  Credit Card </p><p>Bank Transfer Amount to be transferred must be in Euro.  BANK NAME HELLENIC BANK  SWIFT HEBAGRAA  IBAN GR59 0320 0170 0057 0000 1191 600  BANK ADDRESS PANORMOU 68, ATHENS 11523  NAME OF THE ACCOUNT INTERNATIONAL COLLEGE OF DENTISTS</p><p>-Please remember to add bank charges, as the recipient will not pay those. -Please make sure that your name, address, and “53rd ICD Annual Meeting 2008” are clearly stated on all payments and transfer documents.</p><p>Credit card - All registrations will be charged upon confirmation, immediately. In order for your registration to be accepted, the credit card provided must have an expiration date after August 2008. - Credit cards acceptable for payment are Visa and Master Card. Please input correctly your credit card number and expiration date as well as the three (3) digit control number (CVC), which is printed on the back of your credit card. - I authorize Ibis El Greco to use my credit card for the full prepayment of the registration fees, according to the stated terms, which I have read and I totally accept.</p><p>Credit Card Holder Name: Credit Card Type  Master Card  Visa Card Number Valid until Month ______Year ______Remember: Expiration date must be 08/2008 or later 3Digit Code ______After completing the reservation form please:</p><p>- fax to both numbers +30 210 7473 370 and +30 2810 301689 - or e-mail as an attachment to both addresses [email protected] and [email protected] under the subject “Registration for 53rd ICD Meeting 2008”.</p><p>IMPORTANT NOTES:</p><p>- Any additional information regarding registration or other congress issues can be communicated by e-mail in the address [email protected] or by telephone in the congress hotline +30 6944502902</p><p>- For additional pre or post Congress tours and travel information please contact:</p><p>Ibis El Greco S.A. Mrs Maria Leventi 10, Meteoron Str, 71307, Heraklion Crete, Greece e-mail: [email protected] tel: +30 2810 301711 fax: +30 2810 301689</p>