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Registration periocampus INTERNATIONAL
Fill the form to register the course. You will receive the payment details by email
PARTICIPANT
Name and Surname
Profession*
Qualifica
Dentist
Dental Hygienist
Date of birth
Place of birth
Address
ZIP Code
City
Country
Telephone
Mobile
Email
Course
Select course...*
Periocampus International 24, 25, 26, 27 September 2023
INVOICING INFORMATION
Company name
ID / VAT Number
Address
ZIP Code
City
Country
Payment method*
(you will be sent an email with further information)
Pagamento
Bank transfer
Credit card
TERMS AND CONDITIONS
According to Regulation (EU) 2016/679 (General Data Protection Regulation) we provide the due information concerning the processing of the collected personal data. The Data we collect will be handled by Filippo Graziani (Data Controller) and Centar inovativne edukacije d.o.o., Lipanjska 6, HR-10000 Zagreb (Data Processor) that will be responsible for their treatment. Your data won't be shared to anyone without your consent and at any time you can request their amendment or cancellation. Nonetheless, at any time you can ask to be removed from any distribution list we use to share informative or commercial material with a mail to info@periocampus.com.
Terms and Conditions
I fully agree with the Terms and Conditions*
DESIRED ROOM TYPE *
DESIRED ROOM TYPE
DUS room
Double room
I also declare to agree with the following
Location
I declare to fully understand the place and the dates of the event*
Importo e pagamento
I declare to fully understand the price, the methods and the due dates for the payment*
Evento
Data processing for activities connected to the event*
DEM
Communication about new initiatives and promotional material
Privacy
I have read and consent to the processing of personal data as reported in the
privacy policy*
The total fee is € 2400 + VAT (%22), which includes:
All the theoretical and practical sessions of the event
The Periocampus bag
The participation certificate
The 2 nights stay in a 4-star hotel (Any extra nights can be booked through the Organizing Secretariat at +39055576856 or via email through info@periocampus.it)
The cocktail on the first day
The dinner on the second day
The smart lunch on the last day
All coffee breaks between sessions
Payment must be made as follows:
€ 1200 + VAT upon registration
The entire amount should be paid within 30 days of the start of the course
Payment method (you will receive the details by email)
** The course will be held in Italian with simultaneous English translation.
PERIOCAMPUS PATIENTS
Patients
I would like to participate in Periocampus Patients (4th day)
Day 4 is optional and is not included in the Advanced Course fee. It is a full day dedicated to the treatment of real perio patients in Professor Graziani’s dental office, under the careful supervision of the teachers of Periocampus. This last module has a value of € 1,000 + VAT (%22)
Register