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Binding sign up for the following event:

Module set ABC

Organizer:	Dental Innovation GmbH
Place:	BioMedizinZentrum, Dortmund
Referentin:	Dr. Susanne Graser
Education points*	24

We grant a package deal of 1500€ plus VAT if you sign up for the module set ABC and the module D at the same time.

Please choose a date

* The education points are awarded by the organizer for the event above in specification to the BZAK and DGZMK.

Participant details

Occupation

Form of address

Title

First name Please fill out the field.

Last name Please fill out the field.

Participant already uses Freecorder^®BlueFox*

Yes

Please choose one.

Billing address

Practice / Lab / Office Please fill out the field.

Street* Please fill out the field.

Postal code Please fill out the field.

City/Location Please fill out the field.

Form of address

Title

First name Please fill out the field.

Last name Please fill out the field.

Phone

E-Mail* Please fill out the field.

Questions & requests

Please fill out the field.

*Mandatory fields

By signing up you agree to measure yourself if applicable and to complete small assignments between modules. To achieve the ideal learning effect, only participants or test subjects provided by us will be measured during the course. Measuring your own patients is not possible.

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Conditions of participation: Signups are incorporated in order of their arrival. You will receive a sign up confirmation. The registration fee is due, 10 days after the invoice date. If a participant is unable to attend the event, a replacement can be sent. The registration can be cancelled free of charge up to 14 days prior to the event. The registration fee has to be payed in full after this time. You may cancel in written form or by calling us. The DDI-Group reserves the right to change the time and place of the event or to utilize a replacement speaker. The DDI-Group may cancel an event for critical reasons, in which case the payed fees have to be refunden in full. Further claims do not exist..