Registration form - Summer Course: Orofacial pain and dysfunction

Summer Course: Orofacial pain and dysfunction

Registration form
Course dates 2025:

Wednesday July 16
Thursday July 17
Friday July 18
Saturday July 19

Participation fee:

€ 2.995,00

Including:
- 3.5 days of lectures and practicals
- coffee/tea/water during all breaks
- Wednesday, Thursday, Friday lunch
- Thursday dinner at ACTA

To read the full course information click here:

https://acta-de.nl/course/opd-summer-course/.
By completing this form, you confirm your attendance at the Summer Course: Orofacial pain and dysfunction.*

Agreed
The participant
BIG number
Only for dutch participants
Function*
Name*

First name / Initials - as will be shown on the certificateLast name - as will be shown on the certificate
Email address*
Address*

Street address

Street address line 2

Postal / Zip codeCity

Country
Phone Number*
Please enter a valid phone number.
Billing address
Name*

First nameLast name
Company
Optional
Reference / Other necessary invoice information
Optional
Address*

Street address

Street address line 2

Postal / Zip codeCity

Country
Should be Empty:

Summer Course: Orofacial pain and dysfunction