Registration Form
Registration Form
After you complete the registration, notification e-mail (from
jea40@kokuhoken.jp
) will be sent to you automatically.
Please print out the e-mail and bring it to the registratio desk on site.
The deadline for registration is
May 20.
*
fields are required.
* First name
* Last name
* Name of Affiliation
ex. Koku University Graduate School of Dentistry, Koku Dental Clinic
Div. / Department
ex. Department of Special Needs Dentistry
* E-mail address
* E-mail address
(for Confirmation)
Please click the "Confirm" button and check your information carefully.
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