Request a Course

Our courses are designed to work around your schedule. Fill out the form below to request a course for you, your office, or a study club.

Name

Provide the name of the best contact person for scheduling.

First Name

Last Name

Email

Phone

(###)

###

####

Name of Office or Study Club

Address

Please provide the location where the course will be hosted.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Course of Interest

Please choose which course you would like to schedule - Course 1 is required before Course 2.

Approximate Number of Dentists Participating

Please provide an estimate of the number of Dentists participating. This can be changed later.

Questions or Comments

Please include any questions or comments that you have that may be helpful in scheduling.

Number of Dentists

Price per Participant

1-2

3-4

$1895*

$1795*

*Registration fee listed does not include travel and lodging costs for instructor or materials, which shall be paid by course participants.

5+

$1695*