Registration – Practice Pearls

Protecting Your Practice Pearls Registration

$495 for Dentist plus $300 each for up to 2 team members. Because of the structure of this workshop, team members or spouses may not attend without their dentist. All registration confirmations will be sent to the dentist’s email address.

"*" indicates required fields

Dentist Name*

First Last

Practice Name*

Practice Address*

Street Address City State / Province / Region ZIP / Postal Code

Practice Software*

Dentist cell phone*

Dentist Email*

Enter Email Confirm Email

AGD# for CE Credit

Any dietary restrictions? (Please specify)*

Additional Attendee Details & Pricing

How many people are attending*

Choose a pricing plan based on the number of attendees.

1. Additional attendee name*

First Last

AGD# for CE Credit

Position*

Any dietary restrictions? (Please specify)*

2. Additional attendee name*

First Last

AGD# for CE Credit

Position*

Any dietary restrictions? (Please specify)*

3. Additional attendee name*

First Last

AGD# for CE Credit

Position*

Any dietary restrictions? (Please specify)*

Dentist only*

Price:

Dentist and one attendee*

Price:

Dentist and two attendees*

Price:

Dentist and three attendees*

Price:

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Comments

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