Online Course Registration

Soft Tissue Implant Course Monroe Oct 2019




* I hereby register for:
October 10-12, 2019
 

TUITION FEE:

$6,500 Per surgical attendee

($3000 paid at time of registration. Remaining part of tuition fee to be paid 4 weeks prior to course inception)


Please note that all surgical attendees are required to have an active unrestricted Louisiana Dental License in order to actively participate in surgical procedures.



$2,000 Per Observer

($1000 paid at time of registration. Remaining part of tuition fee to be paid 4 weeks prior to course inception)

Louisiana Dental License & proof of your liability insurance coverage NOT required.


 

* I hereby register as:
Surgical attendee
Observer


PERSONAL INFORMATION:

* First Name:
* Last Name:
* Degree(s):
* Specialty:
* Years in practice:
* Previous Implant Experience (choose one of the following options):
No previous implant experience
Have placed some implants
Intermediate experience
Been placing implants for years & consider myself advanced

 

CONTACT INFORMATION:

PLEASE USE THE MAILING ADDRESS THAT YOU WOULD LIKE THE CE VERIFICATION LETTERS TO BE MAILED TO

* Email:
* Cell Phone:
* Work Phone:
* Street Address:
* City:
* State:
* Zip Code:


OTHER INFORMATION:

AGD Member ID:
* Glove Size:
Please specify if you have dietary restrictions:
* How did you hear about the course?
In a few words...What would you like to get out of this course:

 

CANCELLATION POLICY:

Refunds will be made with written notice of cancellation and must be received four weeks prior to the course inception. 

TAX DEDUCTION:

The expense of continuing education may be tax deductible.

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