SICON2024 - LIVE Main delegate information: Please fill in all the fields to ensure registration and invoice generated is accurate.Name(Required) Prefix Dr.MissMr.Mrs.Ms.Prof.Prof. Dr. First Last Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Dietary requirement(Required)SelectNoneGluten-FreeHalaalKosherVeganVegetarianHow did you hear about the course?(Required)SelectEmailSocial Media - FacebookSocial Media - InstagramSocial Media - LinkedInSales RepresentativeWord of mouthOtherDentist 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) Main Conference fees (Monday, 15 April – Wednesday half-day, 17 April) Dentists / Specialists: ZAR10 000 Dental Technicians: ZAR6 000 Dental Assistants / Dental Nurses / Oral Hygienists / Registrars (Auxiliary Staff): ZAR5 000 Optional Innovation Hub Workshops are taking place on Sunday afternoon, 14 April, before the main conference kicks-off on Monday, 15 April Dentists / Specialists: ZAR1 800 Dental Technicians: ZAR1 100 Dental Assistants / Dental Nurses / Oral Hygienists / Registrars (Auxiliary Staff): ZAR 900 Field of speciality(Required)SelectDentistDental AssistantDental TechnicianOral HygienistOral & Maxillofacial SurgeonPeriodontistProsthodontistRegistrarAuxiliary StaffConference Packages - Dentist/Specialist(Required)SelectConference & Workshop (R11 800 incl.)Conference only (R10 000 incl.)Workshop only (R1 800 incl.)Conference Day 1 only: Monday (R3 333 incl.)Conference Day 2 only: Tuesday (R3 333 incl.)Conference Day 3 only: Wednesday (R3 333 incl.)Conference Packages - Dental Technician(Required)SelectConference & Workshop (R7 100 incl.)Conference only (R6 000 incl.)Workshop only (R1 100 incl.)Conference Day 1 only: Monday (R2 000 incl.)Conference Day 2 only: Tuesday (R2 000 incl.)Conference Day 3 only: Wednesday (R2 000 incl.)Conference Packages - Auxiliary Staff(Required)SelectConference & Workshop (R5 900 incl.)Conference only (R5 000 incl.)Workshop only (R900 incl.)Conference Day 1 only: Monday (R1 666 incl.)Conference Day 2 only: Tuesday (R1 666 incl.)Conference Day 3 only: Wednesday (R1 666 incl.)Choose which workshop you are going to attend:(Required)SelectParallel Workshop 1: Anterior AestheticsParallel Workshop 2: Full Arch RehabilitationParallel Workshop 3: Mastering lab techniques for the latest abutmentsThe three workshops run in parallel to each other.Accommodation information: Would you like to book accommodation?(Required) Yes No Which room would you like to book accommodation for?(Required) Single room (R3 300.00 per night, includes breakfast) Double room (R3 600.00 per night, includes breakfast) Accommodation: Single room (R3300 incl.) Price: Amount of nights: Single room(Required)Please enter a number from 1 to 6.Which nights you are staying in a single room:(Required) 12 April 2024 (Friday) 13 April 2024 (Saturday) 14 April 2024 (Sunday: Registration & Optional half-day Workshops) 15 April 2024 (Monday: Academic Lectures & Distributor Evening) 16 April 2024 (Tuesday: Academic Lectures & Gala Evening) 17 April 2024 (Wednesday: Half-day Academic Lectures & Social activity/Excursion) 18 April 2024 (Thursday) If you would like to book additional nights accommodation not listed on the registration form, please send an email with your request to events@southernimplants.com.Accommodation: Double room (R3600 incl.) Price: Amount of nights: Double room(Required)Please enter a number from 1 to 6.Which nights you are staying in a double room:(Required) 12 April 2024 (Friday) 13 April 2024 (Saturday) 14 April 2024 (Sunday: Registration & Optional half-day Workshops) 15 April 2024 (Monday: Academic Lectures & Distributor Evening) 16 April 2024 (Tuesday: Academic Lectures & Gala Evening) 17 April 2024 (Wednesday: Half-day Academic Lectures & Social activity/Excursion) 18 April 2024 (Thursday) If you would like to book additional nights accommodation not listed on the registration form, please send an email with your request to events@southernimplants.com.Partner information:Would you like to bring your partner to the Gala Evening?(Required)An additional fee of R600 will be payable. Yes No Gala Evening Partner Fee (R600 incl.) Price: Partner name(Required) First Last Partner dietary requirement(Required)SelectNoneGluten-freeHalaalKosherVeganVegetarianTransfer information: Would you like to book a transfer?(Required)Transfers are available between King Shaka International Airport in Durban to The Capital Zimbali Hotel. Cost of one-way transfer: R745.00 Yes No Transfers (R745 incl.) Price: Which transfer would you like to book?(Required)- Select -One way (R745)Both ways (R1490)How many people will be travelling in your transfer?(Required)Golf day information: We have a golf event planned for Sunday 14 April 2024. It runs parallel to the Innovation Hub Workshops taking place Sunday afternoon. Would you like to attend the golf event on Sunday 14 April 2024?(Required) Yes No A Southern Implants representative will be in touch to make arrangements for the golf event.Factory tour information: Would you like to attend a factory tour during your trip to SICON2024?(Required)Factory tours are taking place on Saturday 13 April 2024 at Southern Implants Head Quarters in Pretoria, Gauteng. Yes No A Southern Implants representative will be in touch to make arrangements for the factory tour.Consent(Required) I agree to the terms and conditions.SPECIAL DISCOUNT R0.00 REP SPECIAL DISCOUNT R0.00 IBERICA SPECIAL DISCOUNT R0.00 NAMIBIA SPECIAL DISCOUNT R0.00 DISTRIBUTOR DISCOUNT R0.00 Coupon code Tax R0.00 Total *Kindly note American Express cards not supported CaptchaNameThis field is for validation purposes and should be left unchanged.