Datum MM slash DD slash YYYY OSOBNE INFORMACIJE / PERSONAL INFORMATIONIme i prezime(Required) Ime / Name Prezime / Last name PAZITE NA DIJAKRITIČKE ZNAKOVE! Kako unesete svoje ime - tako će biti napisano na akreditaciji i diplomi. USE THE DIACRITICS WISELY! Your name will appear on your accreditation and certificate exactly as you type it.OIB / VAT(Required)Email(Required) Telefon / Phone(Required)Evidencijski broj u HKDM / Registration number in CDC* za ostvarivanje bodova HKDM potreban je evidencijski brojOsobna adresa / Personal address(Required) Ulica i broj / Street an no. Grad / City Poštanski broj / ZIP Code 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 Država / Country KOTIZACIJA / REGISTRATION FEEKotizacija ovisno o paketu uključuje nazočnost stručnom programu Kongresa i radionicama, kongresne materijale, ručkove i kavu u pauzama, kongresni party, bodove HKDM, diplomu za sudjelovanje te diplomu za završen Masterclass. Depending on the package, the registration fee includes attendance at the professional Congress program and workshops, congress materials, lunches and coffee during breaks, CDC credits, a certificate of attendance, Masterclass certificate.Do 16. 3. 2025. / Until March 16, 2025(Required) doktori dentalne medicine / doctors of dental medicine - 350€ dentalni tehničari / dental technicians - 350€ specijalizanti / residents - 350€ studenti / students - 150€ HDEDM članovi / CAADM members - 350€ Do 4. 5. 2025. / Until May 4, 2025(Required) doktori dentalne medicine / doctors of dental medicine - 350€ dentalni tehničari / dental technicians - 350€ specijalizanti / residents - 350€ studenti / students - 150€ HDEDM članovi / CAADM members - 350€ Od 5. 5. 2025. / From May 5, 2025(Required) doktori dentalne medicine / doctors of dental medicine - 350€ dentalni tehničari / dental technicians - 350€ specijalizanti / residents - 350€ studenti / students - 150€ HDEDM članovi / CAADM members - 350€ MASTERCLASS RADIONICE / MASTERCLASS WORKSHOPSPrisustvovanje radionicama je moguće samo uz plaćenu kotizaciju. / Attendance at the workshops is only possible with a paid registration fee.Odaberite Masterclass / Choose MasterClass Masterclass Marat Awdaljan - 300€ Masterclass Kang Chien Ming - 300€ Masterclass Božidar Pavelić - 150€ Masterclass Marat Awdaljan Cijena: Masterclass Kang Chien Ming Cijena: Masterclass Božidar Pavelić Cijena: PLAĆANJE / PAYMENTUVJETI/CONDITIONS Nakon ispunjavanja registracijskog obrasca, primit ćete automatsku e-mail potvrdu o prijavi. Potvrda registracije nije potvrda o uplati. Za dodatne informacije o registraciji obratite nam se na email info-admoment@mpg.hr. Nakon izvršene uplate, račun će biti poslan na adresu platitelja.After filling out the registration form, you will receive an automatic e-mail confirmation of your registration. Confirmation of registration is not confirmation of payment. For additional information about registration, contact us at info-admoment@mpg.hr. After the payment is made, the invoice will be sent to the payer's address. PLAĆANJE/PAYMENT Procedura za bankovno plaćanje: nakon primitka vašeg ispunjenog registracijskog obrasca, poslat ćemo vam ponudu po kojoj ćete izvršiti uplatu.Procedure for bank payment: after receiving your completed registration form, we will send you an offer to make the payment.OTKAZ I POVRAT SREDSTAVA / CANCELLATION AND REFUNDSvi zahtjevi za povrat novca moraju se dostaviti u pisanom obliku kongresnoj agenciji na adresu MPG d.o.o., Nova Ves 17, 10 000 Zagreb ili na e-mail:info-admoment@mpg.hr i moraju biti primljeni najkasnije do 1. travnja 2025. Povrat kotizacije umanjen za administrativne troškove od 20% i PDV biti će vraćen u roku od 15 dana nakon završetka Kongresa. Otkazivanja primljena nakon 1. travnja 2025. neće biti uvažena I kotizacije neće biti vraćene. All refund requests must be submitted in writing to the congress agency at the address MPG d.o.o., Nova Ves 17, 10 000 Zagreb or by e-mail:info-admoment@mpg.hr and must be received no later than April 1, 2025. The refund of the registration fee minus the administrative costs of 20% and VAT will be refunded within 15 days after the end of the Congress. Cancellations received after April 1, 2025 will not be honored and registration fees will not be refunded.ŽELIM DA RAČUN GLASI NA / THE INVOICE SHOULD BE ADDRESSED TOAko želite da račun glasi na drugu osobu ili tvrtku, molimo ispunite sve potrebne informacije. Za osobu koristite ime i prezime, a za tvrtku ime tvrtke. If you would like the invoice to be addressed to another person or company, please fill in all the necessary information. Please use the first and last name of a private person, and the company name for the company. ŽELIM DA RAČUN GLASI NA(Required) Isto kao i osobne informacije / The same as the personal information Želim da račun glasi na / I want the invoice to be addressed to Ime i prezime / First and Last Name(Required)Ime tvrtke / Company Name(Required)OIB / VAT ID / TAX ID:(Required)Adresa / Address(Required) Ulica i kućni broj / Street Name and no. Grad / City Poštanski broj / ZIP Code 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 Država / Country UKUPNO ZA PLATITI / TOTAL PDV uključen / VAT includedConsent(Required) Prihvaćam pravila privatnosti / I agree to the privacy policy(Required)Registracijom na Kongres dajem privolu MPG d.o.o. da me kontaktira kako u vezi kongresa, tako i svih ostalih sličnih skupova vezanih za dentalnu struku. Suglasan / Suglasna sam da moji podaci mogu biti proslijeđeni relevantnim profesionalnim komorama, uključujući Hrvatsku komoru dentalne medicine, radi dodjele bodova za moje pasivno / aktivno sudjelovanje na događanju u organizaciji MPG d.o.o. U svakom trenutku ćete moći kontaktirati MPG d.o.o. i povući ovu privolu.PhoneThis field is for validation purposes and should be left unchanged.
