Bicon Institute Secure Online Course Registration

Please choose a course below:

Bicon Short Implants

Mar. 19, 2010 • Denver CO

FREE!

$1000.00

May 6, 2010		$1,100.00
October 15, 2010		$1,100.00

May 5, 2010		$1,100.00
October 14, 2010		$1,100.00

May 7, 2010		$1,100.00
Oct. 16, 2010		$1,100.00

$750.00

$750.00

$250.00

The tuition fee is per person, non-negotiable and non-transferable.
Registration will be considered complete once payment is made in full.
Due to limited class size, early registration is encouraged.
Refunds will not be made within one month prior to the course.
For the Cartagena Surgical Course, a 20% non-refundable deposit is due with registration. The balance is due one month prior to departure.
In the unlikely event of course cancellation, Bicon is not responsible for travel expenditures.
Tuition does not include travel expenses or hotel accommodations.
For travel related services, please contact Millbrook Travel at (781) 934-0906 or via fax at (781) 934-0072.

How did you hear about this course?
If applicable, which journal?
How did you hear about Bicon?
If applicable, which journal?
What is your specialty?
Name
Address
City, State, ZIP
Province (if applicable)
Country
Phone
FAX
Email
Type comments or questions here...

Payment Information

	Visa MasterCard AMEX
Card Number
Expiration
Signature
Card Security Code	« What's This?

Note: If you prefer, you may call or fax with your payment information. Registration is not complete until payment has been received.
I authorize Bicon to photograph me during the course(s). I understand that these images may be used for educational purposes, publications, brochures, and/or the Bicon website. I understand the photos will not be used in a manner that may be deemed inappropriate. I understand that if I practice in a country where Bicon has a distributor, then I shall purchase all Bicon products from that representative and not from the Bicon office in Boston. I hereby agree to the terms and understand the conditions listed above.
Promotional Code