The First North American MOI Congress
Congress Registration
Thank you for your interest in attending the First North American MOI Congress
Printable Registration Form
First Name
Last Name
Email address
Street Address
City
Prov./State
Country
Postal/Zip Code
Telephone
Your profession
Registration fees
(Early registration 550.00 CAD, Regular registration 650.00 CAD, MOI Alumni 450.00 CAD,
Hands-on workshop 950.00 CAD, Clinic staff members 350 CAD
Mail a cheque payable to The Montreal Society of Implantology
1500 Rome blvd., Brossard, Quebec, Canada J4W 2T4
or fax this form with credit card information to 450 672 0765
Name
Card type
Card number
Expiration date
CVV