In order to register for the FABS Course on 30 November and 1 December 2012, Guia de Isora, Tenerife, we kindly ask you to fill in the online registration form:

Title:	Professor Dr. Mr. Mrs.
Last name
First name
Initials
Address:
Zipcode:
City:
Telephone:
Mobilephone:
E-mail:
Profession	Oral and Maxillo-Facial Surgeon Orthodontist Dental Implantologist Dentist Other
Handicap Golf (if applicable):
Handicap Golf partner (if applicable):

Last name
First name
Initials

			Tarief
A. Program items (delegate)
	Delegate FABS Course 30/11 and 1/12		€800
	Golf Tournament 29/11		€120
	Gala Dinner 1/12		€100
B. Program items (partner)
	Golf Tournament 29/11		€120
	Lunches and cocktail 30/11 and 1/12		€80
	Gala Dinner 1/12		€100
	Totaal

Be aware this registration does not include your flight- and hotelarrangements. Please find flight information of Airport Amsterdam, Brussels and Düsseldorf on the conference website www.tenerife-lecture-2012.aosf.org.

To enable you to make your own hotelreservations at Hotel Abama, you can send an e-mail to Solveig.Koch@ritzcarlton.com and mention the conference code AOSF Meeting.

The total amount needs to be transferred to account before 1 June 2012:
ING Bank 68.05.87.632
Iban NL37 INGB 0680587632 (Bic INGBNL2a)
Payable to: Ireen Rientjes Congresorganisatie, Hengelo, The Netherlands
Subject: FABS Course participants initials and last name
Bankcosts: to the account of participant
Registration will only take place after receiving the course fee.

In case of cancellation of participation before 1 July 2012, registration fees will be refunded deducting a handling fee of € 100,- per person. After this date, there will be no refund.