SEMINARS 2019

Southern California

Payment Detail for Nov. 17, 2019 Seminar
(ENDODONTICS)

  Pre-pay* Door
Dentists (member) $79 $89
Dentists (non-member) $89 $99
Hygienist/R.D.A. (member) $59 $69
Hygienist/R.D.A. (non-member) $69 $79
* The "Pre-pay" rate constitutes a payment made at least 7 days prior to the date of the seminar.
Required fields are marked (*)
   
Seminar ENDODONTICS
Title *
First Name *
Last Name *
Name on Credit Card    *
registering for yourself or other?  *
(If other, please specify name.)
 


Address *
City *
State *
Zip *
Office Phone * e.g. (1234567890)
Cell Phone   e.g. (1234567890)
Email *
  I WANT PDS TO SEND ME THE INFORMATION FOR FUTURE SEMINARS VIA EMAIL
Lic. No. *
  If you don't have a license number type 00000
Security Code*  
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