Application Form

    Title

    Simplantology Series (Study Club)

    Course Director

    Dr. Eric Kook & Dr. Kyle Yang

    Course Venue

    MINIMAX QLD Office, Eight Mile Plains

    Ste 5B/88 Brandl St, Eight Mile Plains QLD 4113

    Course Date & Time

    20 Nov 2026, 5pm-8pm

    Course Fee

    Complimentary

    CPD

    3 Points

    Name

    Ahpra no.

    Clinic Name

    Clinic Address

    Mobile

    Email

    Billing Name

    Billing Address

    Card Holder Name

    Card Number

    Expiry Date

    CVC

    * Your payment will be processed in 1-2 business days. Please keep in mind that all payments made through AMEX have a 2% surcharge.

    * If you have already created an account with our company, you may skip the card details section.

    Allergy / Other (Please Specify)

    What is your interest for attending this course?

    Do you have a promo code?

    Should you have any question/comment?

    Minimax Seminar/Event Cancellation/Refund Policy:
    - Cancellations made 20+ business days before the event: 100% refund
    - Cancellations made 10+ business days before the event: 50% refund + 50% credit
    - Cancellations made within 7 business days: credit only
    - Seats are confirmed only after full payment is received.
    This policy applies to all cancellations, regardless of the reason.
    The personal information provided upon registration may be used for marketing purposes by Minimax Implant.

    Application Form

      Title

      Simplantology Series (Study Club)

      Course Director

      Dr. Eric Kook & Dr. Kyle Yang

      Course Venue

      MINIMAX QLD Office, Eight Mile Plains

      Ste 5B/88 Brandl St, Eight Mile Plains QLD 4113

      Course Date & Time

      20 Nov 2026, 5pm-8pm

      Course Fee

      Complimentary

      CPD

      3 Points

      Name

      Ahpra no.

      Clinic Name

      Clinic Address

      Mobile

      Email

      Billing Name

      Billing Address

      Card Holder Name

      Card Number

      Expiry Date

      CVC

      * Your payment will be processed in 1-2 business days. Please keep in mind that all payments made through AMEX have a 2% surcharge.

      * If you have already created an account with our company, you may skip the card details section.

      Allergy / Other (Please Specify)

      What is your interest for attending this course?

      Do you have a promo code?

      Should you have any question/comment?

      Minimax Seminar/Event Cancellation/Refund Policy:
      - Cancellations made 20+ business days before the event: 100% refund
      - Cancellations made 10+ business days before the event: 50% refund + 50% credit
      - Cancellations made within 7 business days: credit only
      - Seats are confirmed only after full payment is received.
      This policy applies to all cancellations, regardless of the reason.
      The personal information provided upon registration may be used for marketing purposes by Minimax Implant.