Sri Lanka Association of Oral Maxillofacial Surgeons

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					Announcement
   Sri Lanka Association of Oral & Maxillofacial Surgeons
      (http://slaoms.atspace.org, srilanka_oms@yahoo.com)                                      SLAOMS
                                                                             Surgical Update Workshop on Cleft Lip & Palate
  Surgical Update Workshop on Cleft Lip & Palate                                 February 18th & 19th 2008, Peradeniya
               February 18th & 19th 2008
    At Department of OMFS, Faculty of Dental Sciences,
                      Peradeniya                                                Registration Form
                                                                   Name: ………………………………………………………
            Live CLP Surgery Demonstrations by
                  BRIAN SOMMERLAD                                  Postal Address: …………………………………………….
                 eminent cleft surgeon in UK
          (Multimedia relay facility will be available)                                   …………………………………………

                                                                   Contact Mobile Phone:……………….. email ………………
Course Fees (Two days)
Consultants Rs 1500/-                                              I will / will not participate in the surgical update workshop
Juniors       Rs 1000/-                                            I enclose the payment for following:
(Lunch & Tea provided)                                             (a) Registration fees: ……………..
                                                                   (Consultants: Rs 1500, PG Trainees & Residents: Rs 1000)
Details of Hotel accommodation:
                                                                   (b) Hotel Accommodation: …………
Royal Garden Mall –William Gopallawa Road                          Details: Name of hotel:                       room preferred:
Tel: 0812387159/62
                                                                   Total Payment (a+b): Rs …………….
Fax: 0812387163
Type       R/O       B/B        H/B                       F/B      Cheque No:…………………….
Single     2000/-    2350/-     2800/-                    3250/-   Payable to: Sri Lanka Association of Oral & Maxillofacial Surgeons
                                                                   Signature:……………………
Room
Double     2850/-    3600/-     4500/-                    5350/-
Triple     3350/-    4500/-     5800/-                    7100/-   Please send this form with your payment to:
                                                                   Secretary, SLAOMS
                                                                   Dept. of OMF Surgery
Kandyan Arts Residency, Mulgampola                                 Faculty of Dental Sciences
Tel: 0814478076 /0777779811                                        University of Peradeniya, Peradeniya
Web: www.kandyanarts.net
            Single       Double                    Triple
B/B         2000/-       3200/-                    3800/-