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

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    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
    ____________________________________________________________________________________________
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