Registration Information
Day 1 - Treating the Worn Dentition
Day 2 - Treating the Worn Dentition
To expedite the process, please register by phone at 1.866.781.0072
or fill in your answers, print out the form and fax it to 1.480.588.9072
Today's Date: Sep 07, 2010
Course Date:
November 11 - November 13
Doctor's Name:
Mailing Address:
City:
State:
Zip:
Phone:
Fax:
Formal Name of Practice:
What is your CEREC experience level?
I have completed 0 to 50 CEREC restorations
I have completed 50+ CEREC restorations
Email:
Tuition:
$1,650 for doctors
$950 for staff
Full Name
Position
Fee
1.
2.
3.
4.
5.
6.
7.
Credit Card Payment: MasterCard - VISA - Amex
Credit Card:
Security Code:
Expiration Date:
Name on Card:
