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

- Pay the appropriate Subsciption Fees by Cash / Cheque / Transfer / Demand Draft into

Famdent's ICICI Bank Account (Account Name: FAMDENT, Account No. 026305000519,

Location:Lokhandwala, Mumbai) at your closest ICICI Bank, fill the Online Registration

Form & Submit. You will receive immediate confirmation.

*
 NEW/RENEWAL
GET FREE
1 Year (4 Issue)
 Rs. 750/-
Any 1 Famdent Show 2006 VCD
2 Years (8 Issue)
 Rs. 1400/-
Any 3 Famdent Show 2006 VCD’s
5 Years (20 Issue)
 Rs. 3500/-
Any 10 Famdent Show 2006 VCD’s

*Name :
*Date Of Birth:(MM/DD/YY)
Age:
Sex: Male Female
Qualification:
Graduated from:
(Name of Dental College)
*Full Mailing Address:
*Pin Code :
*E-Mail Address:
*Tel No.:
Mobile No:
*Please circle the Sr. No. of VCDs of your choice:
1 2 3 4 5 6 7 8 9
10 11 12 13 14 15 16 17
18 19 20 21 22 23 , 24

Payment Details:
*Cash: Cheque / DD No.
Dated:
Drawn on:
(Name and Branch of Bank)
For Rs.
Amount deposited in ICICI Bank
on (Date)

STUDENT : 1 YEAR Rs. 500/- 2 YEARS RS. 800/- (NO FREE GIFTS)

Student subscriptions - please send attested copy of current college ID card.

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

· Complimentary VCD’s are subject to availability.

· Limited Time Offer: This offer can be stopped at any time at the discretion of FAMDENT.

· VCD’s are strictly for private viewing only. Any unauthorized or Public Screening is prohibited.

· The contents of all CD’s are the views and opinions of the individual speakers. Famdent is not responsible for the same.


FREE GIFTS SUBJECT TO AVAILABILITY AND VALID FOR REGULAR INDIAN SUBSCRIBERS ONLY. NOT VALID FOR STUDENT AND OVERSEAS SUBSCRIBERS