August 2023 Implant Registration Form

    Please complete the fields below and we will contact you to confirm details and next steps to complete your registration:

    Contact Details

    (as you would like it to appear on your certificate)

    (including area code)

    Please attach the following with your application (scanned copies only)

    (working in Australian or New Zealand)

    (not working in Australian or New Zealand)

    2 Referees (Please supply names and contact details)

    NOTE: Please ensure that your passport is current with at least six (6) months validity remaining on either side of your expected course departure and return dates.

    Medical History

    NoYes

    If yes, what?

    NoYes

    If yes, what?

    Package Options - Comprehensive Fee Includes Accommodation

    Early Bird Comprehensive Fee* - $16,140Early Bird Course Only Fee* - $14,690Comprehensive Fee - $16,990Course Only Fee - $15,000

    All fees are in AUD$ *Early Bird 3 months price prior to the course date – 30% deposit paid at the time of registration with the balance due on 3 months prior to the course date. Less than 3 months prior to the course date, full payment is required on registration.

    Please indicate one of the following to confirm your registration

    21-25 Aug 202328 Aug – 1 Sep 2023

    Method of Payment

    Bank ChequeCredit CardEFT Transfer

    Please make payable to: GKRi8 Pty Ltd

    Accounts department will send you an invoice.

    VisaMastercard

    Please note that payment made by credit card will incur surcharge fee.

    Accounts will send you an invoice/receipt.

    Please ensure that you list your name in the description of the payment

    BSB: 015-354

    Account Number: 388 584 371

    Account Name: GKRi8 Pty Ltd

    Amount AUD$ ...................................

    Payment terms and Cancellation Policy: Deposit of AUD$ 30% of the fee to reserve your spot. The full fee is to be paid 90 days before the course start date. Cancellation fee 30 days or more from course start date is 50% of course fee refunded. Cancellation less than 30 days from course start date will incur no refund.

    For further information contact: