Please complete the online registration form below to register for the ITI Scientific Day being held on 16 June 2012. All blocks are mandatory and need to be completed in full. You will be notified within 48hrs of your confirmed registration. If you have not been notified within 48hrs please contact the congress coordinators. Details listed below.

Payment:

Registration fees for the ITI Southern Africa Scientific Day 2012 must arrive at ITI Southern Africa Section at the same time as the registration form, at the latest one week before the congress (by 8 June, 2011). The only currency accepted is South African Rand (ZAR). Accepted methods of payment are strictly Direct Deposit / EFT / Cheque only.

All payments must be made out to: ITI SOUTHERN AFRICA SECTION, indicating the reference “ITI-SA 2012” and the participant’s full name, to identify payment and assign it to your registration. The full registration fee must be received by ITI SOUTHERN AFRICA SECTION to confirm your registration.

Bank Details:

ITI SOUTHERN AFRICA SECTION

Bank:                  First National Bank (FNB)

Branch:              Fourways Mall

Branch Code:   251655

Account No.:     62030137922

Please fax or e-mail proof of payment to ITI Southern Africa Section on either (Fax) 086 621 2922 or (E-mail) iti_sa@mweb.co.za.

Cancellation Policy

The ITI Southern Africa Section must be notified of any cancellations in writing by letter, fax or email. Cancellation and refund requests must be made in writing and faxed to:

086 621 2922 or sent by email to: iti_sa@mweb.co.za.

• A full refund, less a ZAR 250 administration fee, will be given for cancellation and refund requests received prior to 30 April, 2012.
• A 50% refund, less a ZAR 250 administration fee, will be given for cancellation and refund requests received between 1 May and 15 May, 2012.
• No refunds will be issued after 16 May, 2011.

ITI Southern Africa Section 2012 © All Rights Reserved

ITI International Team for Implantology

Peter Merian-Weg 10

CH-4052 Basel, Switzerland

Work Telephone: +41 61 270 83 83

Work Fax:            +41 61 270 83 84

events@iticenter.ch

www.iti.org

ITI Southern Africa Section

Tudor Place

285 Durban Road

Bellville, 7530

South Africa

Work Telephone: + 27 27 850 0823

Mobile:                 + 27 82 301 5641

Work Fax:              086 621 2922

Iti_sa@mweb.co.za

www.itisouthafrica.co.za