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Registration Form

Workflow: From Technique to Art with Precision | A Three-Day Dentistry Masterclass

Event Date & Time: October 24–26, 2025 | 7:30 AM - 4:00 PM

Event Venue: The Penthouse, One World Place, 9th Avenue, BGC Important Note: The lecture will showcase a live demonstration, dental photography, and a live patient case.

Participant Information

Full Name (with professional title)

Degree / Credentials (DMD, DDS, etc.)

Clinic / Institution Address

Contact Number

Email Address

Dietary Restrictions or Preferences

Commitment

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I confirm my participation in the three-day masterclass.

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I understand that registration is limited and non-refundable, but transferable with prior approval.

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I confirm that all information I have provided is accurate and true to the best of my knowledge.

Kindly upload your PRC ID (for verification purposes only).

Size limit: 10 MB

Payment Details

Registration Course Fee: ₱95,000 per Student

Extended Deadline of Payment: October 20, 2025 (Monday) To secure your seat, please complete your payment using the following details: Bank Transfer Bank Name: Chinabank Account Name: Brickmill Corporation Account Number: 1024-0000-4126 Reference: Workflow PH Important Notes: - Please send a copy of your payment confirmation or receipt to [email protected] for verification, using the subject line: “Workflow Registration Course Fee Confirmation.” - Seats are only confirmed once payment has been received and acknowledged via email. - Payments are non-refundable but may be transferable upon request.

Signature & Date

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