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CDEN0109

I hereby order 10 issues of DENTAL TRIBUNE AUSTRIAN EDITION for 55 € (1 year)*❏I hereby order 20 issues of DENTAL TRIBUNE GERMAN EDITION for 70 € (1 year)*❏I hereby order 4 issues of COSMETIC DENTISTRY for 35 € (1 year)*❏ I hereby order 4 issues of ROOTS for 35 € (1 year)*❏ I hereby order 10 issues of DENTAL TRIBUNE ASIA PACIFIC EDITION for 55 € (1 year)*❏ PAYMENT OPTIONS ❏ PayPal subscriptions@dental-tribune.com ❏ Bank Transfer Commerzbank Leipzig Account No.: 11 40 201 Bank Code: 860 400 00 BIC: COBADEFF IBAN: DE57860400000114020100 *plus shipping and handling. Your personal data will be recorded and retained by Dental Tribune International GmbH, which has its registered office in Holbeinstr. 29, 04229 Leipzig, Germany. Your personal data is used for internal purposes only. After the payment has been made, the shipping pro- cess for the subscribed publication(s) will start. The subscription will be renewed automatically every year until it is cancelled six weeks in advance to the renewal date. PERSONAL DETAILS/SHIPPING ADDRESS Name Position Department Organisation Address Country Telephone Facsimile E-mail Date/Signature Dental Tribune International GmbH | Contact: Nadine Parczyk Holbeinstraße 29 | 04229 Leipzig | Germany Tel.: +49 341 484 74 330 | Fax: +49 341 484 74 173 n.parczyk@dental-tribune.com | www.dental-tribune.com Fax form to: +49 341 484 74 173 or subscribe online at www.dental-tribune.com