FAMDENT SUBSCRIPTION FORM

YES ! I want to subscribe NOW & keep myself abreast with the latest in DENTISTRY!

Name :___________________________________________________________________

Date Of-Birth:________________Age:____ Sex: Male / Female_____________________

Qualification:______________________________________________________________

_________________________________________________________________________

Graduated from: (Name of Dental College):_____________________________________

Full Mailing Address:________________________________________________________

_________________________________________________________________________

__________________________________________________Pin Code : ______________

E-Mail Address:______________________________________

Tel No.:_________________ Mobile: _______________________________

Subscription Terms : (Please tick and send appropriate amount )
New Subscription
Renewal Subscription
Within India
Nepal, Bangladesh, Pakistan,
Sri Lanka and Middle East
All Others Countries
1 Year 750/-
(4 Issue)
1 Year US$ 40
1 Year US$ 60
2 Years 1400/-
(8 Issue)
2 Years US$ 70
2 Years US$ 100
5 Years 3500/-
(20 Issue)
5 Years US$ 150
5 Years US$ 200

Student:

1 Year Rs. 500/-, 2 Years Rs. 800/- (Attested College ID copy mandatory)

Please make Cheque / Draft favouring ‘FAMDENT’ payable at Mumbai.
(Outstation cheques please add Rs.50/-).

Student subscriptions - please send attested copy of current college ID card.
Please tick any 2 Patient Education Pads of your choice:

– Implants – Periodontal Diseases – Crowns & Bridges – Wisdom Teeth
– Root Canal Therapy – Veneers – Cosmetic Dentistry

Print this Order Form on your local printer and mail to:

FAMDENT PUBLICATIONS
102, Sapphire Court, 7, Azad Nagar, Behind Apna Bazar, J. P. Road,
Andheri (w), Mumbai - 400 053, INDIA
Tel.: 022 6504 9697/2674 4509 TeleFax: 022 2674 2425
E mail: famdentresponse@gmail.com