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

Dentist cell phone*

Dentist Email*

Enter Email Confirm Email

Dentist 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

Position*

Any dietary restrictions? (Please specify)*

2. Additional attendee name*

First Last

Position*

Any dietary restrictions? (Please specify)*

Dentist only*

Price:

Dentist and one attendee*

Price:

Dentist and two attendees*

Price:

Cancellation Policy*

I agree to the cancellation policy

The Cancellation/Refund Deadline is June 3, 2022. Cancellations must be sent to
protectingyourpracticepearls@gmail.com with “PROTECTING YOUR PRACTICE PEARLS CANCELLATION” in the subject line.
A full refund will be issued (less 20% administrative fee) for cancellations made before May 27, 2022. Refund checks will be mailed within three weeks of the cancellation. Due to the audience size limitation, no refund requests will be approved after May 27, 2022.

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Phone

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