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Continuing Dental Education


Course Pre-Registration (Step 1 of 5)


COURSE INFORMATION

Course Code: 14-DE-006
Course Title: 18th Annual Dental Hygiene Lecture - Headliners: Breaking News and Its Effect on Health Care AND Diet Wars: Today's Dieting Trends and the Impact on Oral and Systemic Health
Course Date: April 25, 2014
 

YOUR REGISTRATION INFORMATION

Your First Name:*
Your Middle Name:
Your Last Name:*
Suffix: Jr.    Sr.
Preferred Name:*
Occupation:* Dentist ($295.00)
Dental Assistant ($195.00)
Dental Hygienist ($195.00)
Dental Lab Technician ($195.00)
Office Staff ($195.00)

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?