World Conference on Oral Laser Application

Sponsored by Society for Oral Laser Application

Programme Content


World Congress on Oral Laser Applications from 21st to 23rd Sept 2012 at Hotel Hilton-New Delhi.

Supporters

Micro Scientific Instruments

Dentsply India

Delhi Tourism

Colgate

unicorn

reisen
21st, 22nd, 23rd September 2012

Register Now


Download Form in Print Version

(in .pdf format)

*First Name:

*M.I.:

*Last Name:

*Address:

*City:

*State:

*Country:
Postal code:

*Phone(Work):

Phone(Home):

*E-mail:

*Mobile :

____________________________________________________________________________________________
*In which year did you begin Dental Practice?:

*Please indicate your profession/position(check all that apply) :
DentistCollege FacultyStudentPost GraduateIndustry/Manuf. Rep.Speciality
Dental College:

City / State:

[text city/state class:box]

Graduation (Year):

Do you use a laser in your practice or Laboratory?:
YesNo
If yes, in what year did you begin using a laser?:

____________________________________________________________________________________________
*TYPE OF MEMBERSHIP REQUESTED:
Active Member: Rs. 9000/-Institutional & Corporate Members Rs. 25,000/-
*PAYMENT METHODS:
CashCheque/DD
Cheque No.:

Bank and Branch:

Date:

Note:Submit completed application along with payments to:
Bank Details :Send DD/or at par cheque Payable at Baroda/Remit to HDFC
For Indian Transactions:HDFC0000429
For International Transactions:HDFCINBBXXX
A/c no. 04292000001292 in name of "Society for Oral LASER Applications" mail form to
Dr.Mohan Vakade on below address or submit form on sola website : www.solaindia.org



____________________________________________________________________________________________
or
____________________________________________________________________________________________

Dr. Naresh Thukral

Dr. Anil C. Shah

Mobile : +919823067396

Mobile : +919913367671

Dr. Mohan Vakade
Hon. Secretary
A-102, Heramb House,
Nr. Govt. Press, Kothi,
Baroda - 390 001 (Gujarat)
mohanvakade@yahoo.com
Mobile : +919824043463

Dr Vivek Hegde
Mobile : +91 9822055434
____________________________________________________________________________________________