day-1 audit registration form

This registration form is for those Doctors who wish to attend the course, but are NOT licensed to practice in the state that they wish o attend the course.

If you are licensed to practice within the state that you are attending the course please click here to REGISTER.

auditing DOCTOR registration form

DESIRED COURSE 

First Name   Last Name 
Address   Suite
City   State   Zip Code    
Phone    
Cellular   Email  
Fax   The fee for auditing a course is $2,650.00
(Full payment is required prior to attendance)

Payment Information

  
Name as printed on Card  
Credit Card Number    Sec #

Expiration Date

  (mm/yyyy)

Please Enter Billing Address

  

          (Use the above address for billing) Yes  No
Address   Suite
City   State   Zip Code

Terms and Conditions

Tuition

(AUDIT) Implant Mentoring - I,     
$2,650.00(Includes lunch, Travel Expenses not included)
       

Payment Policy

Full payment for the course is due upon registration. In the event that the participant is paying by check we will hold a seat tentative reservation for 7-days awaiting delivery of payment. If the check does not arrive then the seat reservation will be relinquished. 

Cancellation Policy

Any cancellation or postponement of attendance, 30 days or more from the attendance date, will result in a 90% refund, with a 10% minimum non-refundable administrative fee will be withheld.

A cancellation or postponement between 15 and 30 days prior to the registered class will result in a 50% refund, with a 50% non-refundable administrative fee to be withheld.

A cancellation or postponement within 14 days of the registered class, no refund will be provided.

  I have read, understand and agree to comply with cancellation policy
 
 

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