Print this form, complete and fax for attention: Birgit Gärtner, fax no: +264 61 235 227, by no later than 25th August 2011.

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

Company details

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 (Please add dialing code):

Fax (Please add dialing code):

Cell:

Registration Fees

Congress Exhibition Fee per Company

Fee for each additional table (Please indicate how many your company requires):

Registration Fee per Representative

Thursday, 15th September Dinner at Kücki’s Pub (This will be for your own account but please state how many people will attend):

Additional fee for late registration (after 25th August 2011):

TOTAL REGISTRATION FEES:

FEE N$

4000.00

4500.00

1500.00

1 500.00

Quantity

TOTAL

________

Total Payment Due

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

TOTAL REGISTRATION FEES DUE:

TOTAL N$

________________

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 Print & Fax Registration form

Evening Functions

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. for spouses

The Hawaiian evening function is a dress-up party.