7th VIP-ZM-Congress - "BIOLOGICAL IMPLANTOLOGY"

REGISTRATION
Binding registration
for the 7 th VIP-ZM-Congress from
17 to 19 September 2021
info@vip-zm.de
fax +49 (0)6734 10 53
VIP-ZM e. V.
Silvaner Straße 13 a | D-55129 Mainz
fon +49 (0)6131 492 41 39 | fax +49 (0)6131 492 41 37
info@vip-zm.de | www.vip-zm.de
FEES: VIP-ZM e.V. members: for free Non-VIP-ZM e.V. members: € 495 Accompanying person: € 90
Title First Name/Surname VIP-ZM e.V. membership number (if available)*
Title
First Name/Surname
VIP-ZM e.V. membership number (if available)*
I / We come with
accompanying person(s) (including street food market without congress participation)
Invoice address
Address
Phone
Dental Office/Laboratory
Zip Code/City/Country
Fax
E-Mail*
By submitting this form, you accept that VIP-ZM e. V. uses and saves your data for the purpose of processing and notifying you concerning the congress registration.You
can cancel your data anytime via: datenschutz@vip-zm.de
Date
* Please mention your E-Mail address and your VIP-ZM e.V.
membership number (if available)! Thank you.
Signature/Dental Office Stamp
Cancellations no later than 14 days before the beginning of the congress are accepted
free of charge. If the cancellation is received later, 50 % of the participation fees will be
charged. Cancellations must be submitted in writing per Fax, E-Mail, or Mail.
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