Course Registration Form

ATTENTION - VIP Members! To receive the VIP Membership discount, you MUST log in before completing this form.
Name(*)
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Registering as:
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Practice or School Affiliation
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Your Mailing Address(*)
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Primary Phone(*)
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email(*)
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Payment Option(*)
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** NO REFUNDS WILL BE GIVEN IF DOCTOR CANCELS INSIDE OF TWO WEEKS. HOWEVER, THE PAYMENT CAN BE USED FOR ANY OTHER WORKSHOP OR SEMINAR WITHIN A TWO YEAR PERIOD.