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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)
Questions：

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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