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Continuing Dental Education


Course Pre-Registration (Step 1 of 5)


COURSE INFORMATION

Course Code: 14-CE-005
Course Title: 8th Annual L.D. Pankey Lecture: "Avoiding Restorative Failures"
Course Date: April 25, 2014
 

YOUR REGISTRATION INFORMATION

Your First Name:*
Your Middle Name:
Your Last Name:*
Suffix: Jr.    Sr.
Preferred Name:*
Occupation:* Dentist ($195.00)
Dental Assistant ($45.00)
Dental Hygienist ($45.00)
Dental Lab Technician ($45.00)
Office Staff ($45.00)

Sex: Male    Female
Is this your 1st time registering for a course?
yes no
Do you have a disability or special need?
yes no
Do you need to register additional people?
If so, how many?