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Registration Forms Keynote Speakers Powered By Docstoc
					                                                                                                                                        Keynote Speakers
Registration Forms
                                                                                                                                                           Dr. Galip Gürel graduated from the Istanbul University, School
(1) Dentists / Therapists / Technicians                              (3) Dental Assistants/Oral Hygienists/Receptionists                                   of Dentistry and further continued his education at the
                                                                                                                                                           University of Kentucky, U.S.A., in the department of
K PROF            K DR       K MR            K MRS      K MS         K MR              K MRS       K MS                                                    prosthodontics.
                                                                                                                                                              He is the founder and president of EDAD (The Turkish
                                                                                                                                                           Academy of Esthetic Dentistry). He is the editor-in chief of the
SURNAME:                                                             SURNAME:
                                                                                                                                        Quintessence Magazine in Turkey and on the editorial boards of the AACD
                                                                                                                                        journal as well as the Spectrum.
FIRST NAME:                                                          FIRST NAME:
                                                                                                                                           Being one of the true pioneers in this field, he lectures extensively all over
                                                                                                                                        the world and is a visiting lecturer at the Center for Continuing Education at
EMAIL:                                                               EMAIL:
                                                                                                                                        New York University, College of Dentistry, lecturing on the latest advances in
                                                                                                                                        esthetic dentistry. He is a diplomat of the American Board of Aesthetic Dentistry.
TEL:                                 FAX:                            TEL:                                 FAX:
                                                                                                                                           Dr. Gürel maintains a private practice in Istanbul, Turkey, where he
                                                                                                                                        specializes in esthetic dentistry.
MOBILE:                                                              MOBILE:
                                                                                                                                                         Dr Fernando Rojas Vizcaya, DDS, MS
DP/HPCSA NO:                                                         DP/HPCSA NO:
                                                                                                                                                         Dr. Rojas is Adjunct Assistant Professor in the Department of
                                                                                                                                                         Prosthodontics at the University of North Carolina in Chapel
With Annual Med-Bay Membership                                       With Annual Med-Bay Membership
                                                                                                                                                         Hill, NC. He is the Founder and Director of the
         Until 16 July 2010         1 DAY:      R1 450.00                   Until 16 July 2010 1 DAY: R 825.00                                           “Mediterranean Prosthodontics Institute” and maintains a
         From 17 July 2010          1-DAY:      R1 780.00                   From 17 July 2010  1-DAY: R1100.00                                           private practice limited to dental implant surgery and
                                                                                                                                        prosthodontics in Castellón, Spain, and he lectures extensively worldwide. His
Special meals :          K Kosher __________ K Halaal _________      Special meals :           K Kosher _________ K Halaal __________   major research interest includes aesthetic management in complex dental
(R100.00 surcharge per person per day) Amount R_____________         (R100.00 surcharge per person per day) Amount R____________        implant cases in immediate placement and immediate loading protocols, and
                                                                                                                                        bone regeneration with different bone graft materials.
Total Amount: (1) R___________________________________               Total Amount: (3) R__________________________________
                                                                                                                                                          Dr David Klaff Past-President and Founding Member of the
(2) Practice Packages:                                               (4) Sunday 29 August 2010 - Dr David Klaff                                           British Academy of Aesthetic Dentistry (BAAD), David Klaff
                                                                                                                                                          gained his degree at the University of the Witwatersrand,
         Valid until 16 July 2010   1 DAY                                Lecture and Hands-on Workshop                                                    South Africa, in 1967. After serving in the armed forces he
         K Dentist + 2              R2 825.00                                                                                                             went to London where he has maintained a private office, as
         K Dentist + 3              R3 650.00                        Registration Fee: R300,00 for delegates registered for                               a specialist in Prosthodontic Dentistry and limited to restorative
         K Dentist + 4              R4 475.00                        Nomads Day on Saturday 28 August 2010                              and prosthodontic dentistry. He is a member of the American Academy of
                                                                                                                                        Restorative Dentistry, a member of The European Academy of Osseointegration
Special meals :          K Kosher __________ K Halaal __________     Registration Fee: R750,00 if not registered for Nomads             and Association of Dental Implantology, an Active Member of the European
(R100.00 surcharge per person per day) Amount R______________        Day on Saturday 28 August 2010                                     Academy of Esthetic Dentistry as well as the American Academy of Esthetic
                                                                                                                                        Dentistry. He is on the editorial board of Aesthetic and Implant Dentistry. He is
Total Amount: (2) R___________________________________               Limited to 15 delegates. To register, please contact               associate Professor in Aesthetics at the University of Catalonia, Barcelona and
                                                                     Marilize at 083 3398 911                                           is currently serving as the Treasurer of the International Federation of Esthetic
Contact Marilize van der Linde                                                                                                          Dentistry. He lectures extensively in the United Kingdom as well as Europe, the

Tel: 022-715 1919 • Fax: 086 568 4775 • Cell: 083 3398 911           Total Registration Fees                                            United States and Asia on restorative and prosthodontic topics with a special
                                                                                                                                        interest in implantology, occlusion and adhesive dentistry.
E-mail: marilize@adept.co.za                                         (1)    Dentists/Therapists/Technicians Amount: R__________
Payment by cheque or electronic transfer. Indicate surname and tel   (2)    Practice Packages               Amount: R__________                           Trisha E. O’Hehir, RDH, BS, OM
number as reference. Bank Details: Nomads, Nedbank - Sandown                                                                                              • Editorial Director - Hygienetown
                                                                     (3)    Oral Hygienists/Dental Assistants/Receptionists
Branch code: 146905 • Account number: 1933 221 046 Fax                                                                                                    • President of Perio Reports Press
registration form and proof of payment to 086 568 4775 or email to                                          Amount: R__________                           • International Speaker
marilize@adept.co.za Registration will be confirmed once proof of           Total Amount                         R__________________                      • Instrument Designer
payment has been received.                                                                                                                                • Author of The Toothpaste Secret
                                                                     NO REFUNDS WILL BE GIVEN AFTER 20 JULY 2010                                          • Also known as the Oral Health Detective
NO REGISTRATIONS WILL BE PROCESSED WITHOUT PROOF OF PAYMENT

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