Registration Form

• ◆After you complete the registration, notification e-mail (from jspd61@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 April 17th.



• First name ※Required 
  

  Last name ※Required 
  

  Name of Affliation ※Required 
  
  ex. Koku University Graduate School of Dentistry, Koku Dental Clinic

  Div. / Department
  
  ex. Department of Special Needs Dentistry

  E-mail address ※Required 
  

  Category ※Required 

  DentistPara-dental

  Banquet ※Required 

  Attend(9,000JPY)Not Attend

  Please click the "Confirm" button and check your information carefully.
  
  .