REGISTRATION FORM
 
 

Dental Auxiliary & Undergraduate Students

Dentists

On-Site Registration

Early Registration

On-Site Registration

Early Registration

500 SR

400 SR

800 SR

600 SR

 

- 100 SR. for PAAOMS, SSOMS Members

 

A-- Cash Payment:
Ms.Norah Al-Akoor
(King Fahd Hospital – Jeddah, Al-Mosadia, 2nd floor, OMFS secretary room No. 989)

Tel. : +9662 6606111 Ex. 1989
Fax : +9662 6692123
Mobile : +966 546470123

B-- Bank Payment:
Al-Arabi Bank, (Dr. Emad. Pan Arab Association for Oral and Maxillofacial Surgery)
account no. ( SA 6330400108058012050026 )
& send receipt on Fax No. +9662 6692123 or E-Mail : paaoms@gmail.com

 

 

Gender Male Female
  O.M.F.S Dentist D. Hygienist
D. Assistant D. Technicians Student
First Name:
Middle Initial:
Last Name:
Email Address:
Mobile Number:
Fax Number:
P.O.Box:
City / Country
Organization: