Implant Maintenance Course Registration Page

Implant Maintenance Course (Bloemfontein) - July 2025

LTD Mentorship Academy in Partnership with Southern Implants
19 July 2025

Delegate information:

Please fill in all the fields to ensure registration and invoice generated is accurate.

Name(Required)

Prefix First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Dietary requirement(Required)

If your dietary requirement is not listed above, please specify it in the 'food allergies' field to the right.

Food Allergies(Required)

Please let us know if you are allergic to any food.

How did you hear about the course?(Required)

Dentist Practitioners (DP) number

(In order to submit points to the Dental Professions Board)

Company/Practice name to be included on tax invoice?

(If applicable)

VAT number

(If applicable)

Field of speciality(Required)

Coupon

Implant Maintenance and Surgical Setup Course Fee(Required)

Price:

(VAT exclusive amount)

Tax

R0.00

Tax

R0.00

Total

*Kindly note American Express cards not supported

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Email

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