Delegate Registration Form Title * Name * First Name Last Name HPCNA Number * Email * Phone (###) ### #### Academic Institution Special Dietary Requirements NDA MEMBER- N$ 5 200 NON-NDA MEMBER (INCLUDING SADA MEMBERS)- N$ 8 000 DENTAL INTERN Will you attend Congress Evening Gala on Friday 26/09/25 (price included in the congress fee) Yes No Will you bring a plus 1 (additional cost of N$ 1 000)? Yes No Thank you for your submission!NDA Member- N$ 5 200Non NDA Member- N$ 8 000Additional N$ 1 000 for a ‘plus 1’ for a Friday Night GalaKindly make a payment to:Bank WindhoekBranch 483 872Maerua MallAccount no 8000 664 742
