Contact Details

Badge Details

Please indicate your name as you would like it displayed on your name badge.

How did you hear about the conference?

Registration Options

Please select your registration type. 
Early bird rates are available until 11:59pm AEST Sunday 3 August 2025. 
All prices are in AUD & inclusive of GST.

 

If you are paying by credit card, a 3.5% merchant fee will be added to the ticket price at the time of purchase.

AMOUNT
1,584.00
TOTAL
AMOUNT
1,980.00
TOTAL
AMOUNT
1,056.00
TOTAL
AMOUNT
1,320.00
TOTAL
AMOUNT
792.00
TOTAL
AMOUNT
990.00
TOTAL
AMOUNT
616.00
TOTAL
AMOUNT
770.00
TOTAL

Friday Only Registration Options

If you wish to only attend Friday 26 September, please select from the options below.

AMOUNT
1,200.00
TOTAL
AMOUNT
1,000.00
TOTAL
AMOUNT
249.99
TOTAL

Home or Business Address

Business Name

Billing Address

Educational Institution Details

Dietary Requirements

Please note your dietary requirements by using the below drop-down menu. If you have a food allergy, please also make note of this in the below section.

Additional Information

Emergency Contact

Privacy Disclaimer

The information on this form is being collected by Dentsply Sirona Pty Ltd ('DS') in accordance with its Privacy Policy (https://www.dentsplysirona.com/en-au/legal/privacy-policy.html). The information will also be disclosed by DS to the organisers of the Event - [EP Agency Pty Ltd] (‘EP’) and managed by EP in accordance with its Privacy Policy (https://epagency.com.au/privacy-policy/).

By submitting this form, you consent to DS collecting the information on this form so that it can be used by DS and EP to contact you in relation to your participation in the Event. If you do not provide the mandatory information that is requested on this form, it may not be possible for us to complete your registration for the Event or issue your ticket for the Event. For further information about DS's Privacy Policy, please contact DS at ANZPrivacyOffice@dentsplysirona.com. For further information about EP Agency’s Privacy Policy, please contact EP Agency at info@epagency.com.au .

If you indicate below that you would like to receive marketing and other promotional communications from DS and the sponsors of the Event, the information on this form will also be:

  • used by DS to provide you with such communications; and
  • shared by DS with the sponsors of the Event so that they may also contact you for marketing and other promotional purposes.

Summary

Terms and Conditions

Payment

Thank you for completing your registration

Thank you for registering to attend Restorative Dentistry: Back to the Future with Prof Markus Blatz.

You will receive a confirmation email shortly. 

If you do not receive a confirmation email in the next 90 minutes, please contact the Events Team to confirm your registration and payment have been received.

If you have any questions, please feel free to reach out to the Events Team.

E: registration@epagency.com.au 

T: 02 8356 5600

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