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* Required Field.
* Name:
* Occupational category: Dentists Others
* Address:
Zip code:
* Phone Number:
* FAX Number:
* E-mail Address:
* Contents of an application :
 Registration Fee (Dentist)50,000 JPY
 Registration Fee (Others)25,000 JPY
 Hands-On B
    (Microendo; micro-surgery)
252,000 JPY / one pair (two persons)

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<Bank account for remittance >
Bank Name: The Bank of Tokyo-Mitsubishi UFJ,LTD.
Branch: Ginzadori (Branch Code: 024), SWIFT Code: BOTKJPJT
Account No: Saving Account 024-0132350, Account Name: Ishii Hiroshi