Registration Information
Level 2 - CEREC Mastery - Rapid Integration Into Your Practice
To expedite the process, please register by phone at 1.866.781.0072
or fill in your answers, print out the form and fax it to 1.480.588.9072
Today's Date: Feb 04, 2012
Course Date:
February 23 - February 24
May 17 - May 18
May 19 - May 20
June 07 - June 08
July 12 - July 13
September 15 - September 16
November 10 - November 11
December 06 - December 07
Doctor's Name:
Mailing Address:
City:
State:
Zip:
Phone:
Fax:
Formal Name of Practice:
What is your CEREC experience level?
I have completed 0 to 50 CEREC restorations
I have completed 50+ CEREC restorations
Email:
Tuition:
$2,500 doctor
$900 staff
Full Name
Position
Fee
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2.
3.
4.
5.
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7.
Credit Card Payment: MasterCard - VISA - Amex
Credit Card:
Security Code:
Expiration Date:
Name on Card:
