Dentalk Seminars
 20 Carpenter Street
Brighton VIC 3186 Australia

Video Order
Telephone  +61 (3) 9502-5055
Facsimile  +61 (3) 9592-5866

Name __________________________________________________
Street __________________________________________________
Suburb _________________________
State __________
Postcode __________
Country _________________________

Ref. # Title Price Tick
01 Direct Resin Laminates A$50.00 tickbox.jpg (952 bytes)
02 New Restorative Techniques A$50.00 tickbox.jpg (952 bytes)
03 Direct Fibre Reinforced Resin Bridge A$50.00 tickbox.jpg (952 bytes)
04 Occlusal Reconstruction Using Composite Resin A$50.00 tickbox.jpg (952 bytes)
05 Direct Resin Reinforced Crown A$50.00 tickbox.jpg (952 bytes)
06 The Preventive Glass Restoration A$50.00 tickbox.jpg (952 bytes)
07 Indirect Reinforced Resin Bridge A$50.00 tickbox.jpg (952 bytes)
Postage, handling Insurance Australia & New Zealand A$12.00 tickbox.jpg (952 bytes)
Airmail and Insurance to all other Destinations A$25.00 tickbox.jpg (952 bytes)

Video Cassette Format
tickbox.jpg (952 bytes) PAL tickbox.jpg (952 bytes) NTSC
Video Discount
# of Videos 1 2 3 4 5 6 7
A$ 50.00 90.00 130.00 160.00 200.00 240.00 270.00
Payment Type
Please debit my Credit Card tickbox.jpg (952 bytes) A$__________
Please find enclosed a Bank Cheque in tickbox.jpg (952 bytes) A$__________
Credit Card Details
tickbox.jpg (952 bytes) Visa tickbox.jpg (952 bytes) Mastercard
Name on the Card ________________________________________
Card Number ______________________________
Card Expiry Date _____/_____