REGISTRATION FORM



15th Annual Congress of the EADPH
European Association of Dental Public Health

09-11 September 2010 in Constanta, Romania
Venue: Hotel Malibu, Mamaia Resort

Name and contact information
CS
Conference registration 
Early registration fee
before July 1, 2010
Late registration fee
from July 1, 2010
Member EADPH:
Member ARSPOD & EADPH:
Social program
Hotel registration

(Date yyyy-mm-dd, between 2010-09-05 and 2010-09-15)

(Date yyyy-mm-dd, between 2010-09-05 and 2010-09-15)
Payment
We accept Visa, Mastercard, Diners, Eurocard, American Express and Bank transfer.

For Bank transfer:
Account Name: Asociatia Romana de Sanatate Publica Orodentara (ARSPOD)
Bank Name: Banca Transilvania
Branch Name: Constanta / Ag.Tomis
Branch Code: 31314004
Address of Branch: B-dul Mamaia Nr. 134, Constanta, Romania
Account Number: RO54BTRL01404205D00468XX (EURO)
SWIFT Code: BTRLRO22

Please send us a copy of the payment proof
by fax: 0040-241-665727 or e-mail: amariei@oralhealth.ro

Terms of payment/ cancelation
All cancelations or changes must be in writing by email to amariei@oralhealth.ro
For cancellations received by July 1 a refund minus a handling fee of 50.00 Euro will be granted. No refunds can be made
after this date. Name changes will be effected free of charge.
Please note that payment for your accomodation must be made at check in.
Special Interest Working groups
On Friday morning (9 September), six working groups will be offered simultaneously.
Due to the limited number of seats, bookings will be made on a first come -first served basis. Please indicate your choice so
that the organizer may allocate seats accordingley.