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Excellence in Orthodontics and Dentofacial Orthopeadics P.O. Box 6151 UNSW Sydney, NSW 1466 Sydney, Australia Ph: +61 2 9398 8338 E-mail: [email protected] www.eodo.com REGISTRATION FORM FOR 3 YEAR ORTHODONTIC MINI RESIDENCY PROGRAMME 2018 - 2020 SURNAME: ____ FIRST NAME: ADDRESS: CITY: STATE: POSTCODE: COUNTRY: PHONE: EMAIL: How did you hear about our course? - Colleague Alumni Internet Advert (please specify name of Magazine) ___________________ Other ___________ PAYMENT METHOD VISA MASTERCARD BANKCARD AMEX NAME ON CARD: CARD NO. EXPIRY DATE: CCV. NO. OR - I HAVE ENCLOSED A CHEQUE MADE PAYABLE TO EODO FOR THE AMOUNT OF $ . PAYMENT / FEES All courses require a 50% Deposit to hold your place. Per course: AUD $2,500.00 (incl GST) - Includes Theory & TYPODONT session (3 days in total)(C1-6) Pay for 1 year upfront to receive 5% discount. Pay for 2 years upfront and receive 10% discount Pay for 3 years upfront and receive 15% discount CANCELLATION POLICY All cancellations must be made, in writing via email, to [email protected] . Where no written notice of cancellation is given, or a failure to attend the course, there will be no refund issued. For all cancellations, an administration fee of $100 will be charged. Cancellations made 4 weeks prior to the course start date are refunded in full.* Cancellations made within 2-4 weeks of the course start date will be refunded to 50 percent.* Cancellations made within 1-2 weeks of the course start date have an option of a 25 percent credit on the account, to be used for future courses, but there is no refund.* * If the original payment was made by credit card, the credit card transaction fee cannot be refunded. Please send this form back to EODO via email ([email protected] ), or post (P.O. 6151, UNSW Sydney NSW 1466)

REGISTRATION FORM FOR 3 YEAR ORTHODONTIC MINI … · Excellence in Orthodontics and Dentofacial Orthopeadics P.O. Box 6151 UNSW Sydney, NSW 1466 Sydney, Australia Ph: +61 2 9398 8338

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Page 1: REGISTRATION FORM FOR 3 YEAR ORTHODONTIC MINI … · Excellence in Orthodontics and Dentofacial Orthopeadics P.O. Box 6151 UNSW Sydney, NSW 1466 Sydney, Australia Ph: +61 2 9398 8338

Excellence in Orthodontics and Dentofacial Orthopeadics

P.O.Box6151UNSWSydney,NSW1466Sydney,AustraliaPh:+61293988338E-mail:[email protected]

REGISTRATIONFORMFOR3YEARORTHODONTICMINIRESIDENCYPROGRAMME2018-2020

SURNAME: ____ FIRSTNAME:

ADDRESS:

CITY: STATE: POSTCODE:

COUNTRY: PHONE:

EMAIL:

Howdidyouhearaboutourcourse?-Colleague AlumniInternet

Advert(pleasespecifynameofMagazine)___________________Other___________

PAYMENTMETHOD

VISA MASTERCARD BANKCARD AMEX

NAMEONCARD:

CARDNO.

EXPIRYDATE: CCV.NO.

OR-IHAVEENCLOSEDACHEQUEMADEPAYABLETOEODOFORTHEAMOUNTOF$ .

PAYMENT/FEESAllcoursesrequirea50%Deposittoholdyourplace.Percourse:AUD$2,500.00(inclGST)-IncludesTheory&TYPODONTsession(3daysintotal)(C1-6)Payfor1yearupfronttoreceive5%discount.Payfor2yearsupfrontandreceive10%discountPayfor3yearsupfrontandreceive15%discountCANCELLATIONPOLICYAllcancellationsmustbemade,inwritingviaemail,[email protected],orafailuretoattendthecourse,therewillbenorefundissued.Forallcancellations,anadministrationfeeof$100willbecharged.Cancellationsmade4weekspriortothecoursestartdatearerefundedinfull.*Cancellationsmadewithin2-4weeksofthecoursestartdatewillberefundedto50percent.*Cancellationsmadewithin1-2weeksofthecoursestartdatehaveanoptionofa25percentcreditontheaccount,tobeusedforfuturecourses,butthereisnorefund.**Iftheoriginalpaymentwasmadebycreditcard,thecreditcardtransactionfeecannotberefunded.

PleasesendthisformbacktoEODOviaemail([email protected]),orpost(P.O.6151,UNSWSydneyNSW1466)

Page 2: REGISTRATION FORM FOR 3 YEAR ORTHODONTIC MINI … · Excellence in Orthodontics and Dentofacial Orthopeadics P.O. Box 6151 UNSW Sydney, NSW 1466 Sydney, Australia Ph: +61 2 9398 8338

Excellence in Orthodontics and Dentofacial Orthopeadics

P.O.Box6151UNSWSydney,NSW1466Sydney,AustraliaPh:+61293988338E-mail:[email protected]

REGISTRATIONFORMFOR3YEARORTHODONTICMINIRESIDENCYPROGRAMME2018-2020

2018

CourseI 24-25 February 2018

OrthodonticDiagnosisandTreatment Planning

CourseII 13-14 May 2018 Cephalometrics and Orthodontic Treatment Planning

CourseIII 30 June- 1 July 2018 MYOFUNCTIONAL THERAPY & PAEDIATRIC OSA: Treatments in Primary Dentition and Breaking Habits

CourseIV 28-29 July 2018 MIXEDDENTITIONTREATMENTS

CourseV 27-28 October 2018 STRAIGHTWIRE:BracketPlacementandArchWireProgression

CourseVI 8-9 December 2018 STRAIGHTWIRE:MechanicsandTroubleshooting

2019 CourseVII 9-10 February 2019 CLASS II CORRECTION

CourseVIII 20-21 April 2019 CLASSIIICORRECTION

CourseIX 29-30 June 2019 OrthodonticBiomechanics

CourseX 24-25 August 2019 TREATMENT OF EXCESS VERTICAL

DIMENSION CourseXI 19-20 October 2019 TREATMENTOFOVERCLOSEDVERTICAL

DIMENSION CourseXII 7-8 December 2019 PERIO/ORTHOINTERFACE

ACCELERATEDORTHODONTICS

2020 CourseXIII 8-9 February 2020 PROSTHO/ORTHO INTERFACE

DIGITAL SMILE DESIGN CourseXIV 11-12 April 2020 ENDO/ORTHO INTERFACE

TREATMENT OF TRAUMATIC INJURIES CourseXV 20-21 June 2020 AESTHETIC ORTHODONTCS/ADULT

ORTHODONTICS LINGUAL BRACES & CLEAR ALIGNERS COSMETIC INJECTABLES

CourseXVI 15-16 August 2020 TREATMENT OF OROFACIAL PAIN/TMD/BRUXISM

CourseXVII 17-18 October 2020 SURGICAL ORTHODONTICS & SKELETAL ANCHORAGE/ TADs

CourseXVIII 5-6 December 2020 Case Finishing and Retention**NOTE**:ALLDATESARESUBJECTTOCHANGE.Duringthecourse,therecouldbesomechangestothevenueforclinicalday.Shouldthishappen,youwillbenotifiedviaemail,wellinadvance,regardingthevenue/datechange.

PleasetickonetospecifywhichTYPODONTDAY(Course1-6)youwouldprefertoattend.Pleasenotetherearelimitedspacesavailableforeachtypodontdayoncespacesarefull,wewillnotbeabletoaccommodateyourchoice.

Friday Monday

Page 3: REGISTRATION FORM FOR 3 YEAR ORTHODONTIC MINI … · Excellence in Orthodontics and Dentofacial Orthopeadics P.O. Box 6151 UNSW Sydney, NSW 1466 Sydney, Australia Ph: +61 2 9398 8338

Excellence in Orthodontics and Dentofacial Orthopeadics

P.O.Box6151UNSWSydney,NSW1466Sydney,AustraliaPh:+61293988338E-mail:[email protected]

Pleasenoteonceyouhavemadeyourchoiceyouwillnotbeallowedtochangeyourdayunlessyouareabletofindsomeonetoswapyourdaywith.