Course Title: Stress Free Endo and Restoration of the Endodontically Treated Tooth
Course Date: October 24, 2008 Time: 9:00 am – 1:00 pm
(Registration at 8:30 am)
Faculty: Dr. Allan S. Deutsch
Cost: $39.95
Do you require a special dietary meal:
How did you hear about the seminar?

First Name: Last Name:
ADA Member: AGD Member: ADA/AGD No:
Practice Name:
Billing Address:
 
City: State: Zip:
Country:  
Phone: Fax:
E-Mail:
General Practice: Endodontist: List other Specialty:
Year of Graduation:
Name as it appears on Credit Card

Credit Card: Credit Card No.:

Exp. Date: Month Year:

By submitting this registration form I understand that $39.95 will be billed to my credit card. This fee entitled me to attendance at the above course held at Westin Hotel, 650 N. Pearl Street, Dallas, Texas 75201.

Cancellation Policy: Cancellations received prior to five full business days before the date of the seminar will be honored. Later cancellations will incur a $25.00 fee. If notification of cancellation is not received prior to the day of the seminar, no refund will be issued.

 Please hit submit button only once. You will be sent a verifying email.
Additional easy ways to register:
1.
Call: 1-888-5-Hands-On
2.
Check: Essential Dental Seminars
  (mail completed form with check payable to:Essential Dental Seminars) 89 Leuning Street, 2nd Floor
  S. Hackensack, NJ 07606
Essential Dental Seminars is a divison of Essential Dental Systems, Inc.