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Business Name *
Position *
License Number for CE Tracking *
If you are an AGD Member, please provide your member number.
Additional Attendees * Please enter additional attendee name, email, position, and license number. This ensures all in attendance receive full credits for license.
Cancellation Agreement * If you are unable to attend the event, please notify our team as soon as possible at Office@CustomDentalSolutions.com. Due to the limited seats available and nature of the event, there will be no refunds for cancellations occurring after May 9, 2022. Any cancellations prior to May 9, 2022 will incur a $25 administrative fee if it is a paid course. Please checkmark that you agree to these terms.
How did you hear about this course? *
Registration confirmation will be emailed to you.
