To register on-line, complete this form and click the 'submit' button at the bottom of the page. Please register by no later than 25th August 2011

This form is for use by Dental Traders only. Other delegates, dentists and dental auxiliary personnel: Click here for the Delegates Registration form.

Company details

Type the required information in the space provided below:

Total Payment Due

Summarise your total payment due in this table. Please see the payment details below.

All payments to be done, either by electronic fund transfer or by direct deposit, to the following cheque account:

Account name: Namibian Dental Association

Bank name: Bank Windhoek, Maerua Mall Branch

Branch code: 483 872

Account number: 8000 664 742

Fax proof of payment for attention: Birgit at +264 61 235 227 or e-mail to dmsup@mweb.com.na

Please note: For security reasons and due to the long delays experienced the NDA does not accept payments by post office mail.

Advertisements on the NDA Website: Included in the exhibitors registration fee is a free advertisement for twelve months in the 'Dental Traders Forum' on the NDA website. Please have a look at DENTAL TRADERS FORUM on www.namibiadent.com and e-mail your company logo and advertisement to namibiadent@gmail.com

Cancellation/Substitution Policy: Cancellations received 20 or more working days before the congress will be refunded, less a 30% administration fee. No refunds will be made for cancellations received less than 20 working days before the congress or for non-attendance of the congress. Only written notice of cancellations will be considered. Substitutions of persons attending can be made at any time.

Accommodation: All traders and representatives are responsible for making their own accommodation arrangements. Please see the Congress Pages for more information.

NOTE THAT ALL BAR FACILITIES AT THE CONGRESS VENUE OR ANY OF THE FUNCTIONS ARE STRICTLY CASH BAR ONLY!!

2011 NDA Congress & AGM - Dental Traders On-line Registration form

To register on-line, complete this form and click the 'submit' button below.

Registration Fees

The registration fees are to be confirmed soon

Exhibition fee per company (First table): N$ 4 000-00

Fee per additional cubicle/table (Please indicate how many are required): N$ 4 500-00

Fee per representative N$ 1 500-00

Additional fee for late registration (after 25th August 2011): N$ 1 500-00

Calculate your registration fees and enter after each respective colon in the block below. Also enter the total registration fees due.

PLEASE COMPLETE Company Name: 1st Representative's Surname & First name: 2nd Representative's Surname & First name: 3rd Representative's Surname & First name: Postal address: Town: Country: e-mail address: Telephone & dialing code: Fax & dialing code: Cell:

PLEASE COMPLETE Exhibition fee  @ N$4 000-00 per company: Additional table/cubicle @ N$4 500-00  per table/cubicle: Representative registration fee @ N$1 500-00   per representative: (This will be for your own account but please state how many people will attend): Additional late registration fee (after 25/08/11) @ N$1 500-00 EVENING FUNCTIONS Please note: The first evening is on everyone’s own account. The Hawaiian evening function is at an additional amount of N$300.00.  However, prior notification is necessary, as seats are limited. The Hawaiian evening function is a dress-up party. TOTAL REGISTRATION FEES: N$

PLEASE COMPLETE TOTAL REGISTRATION FEES DUE: