Course Registration for  Attending Doctors

If you are a Doctor and would like to enroll in a Mentoring Course please fill out form. If you would prefer to speak with a registration customer service person please call: 877.339.4537

DOCTOR  Registration

COURSES 
**Doctors, must register within the state in which they hold a valid dental license.

** If you are a Doctor who would like to attend the  course, however you are not currently licensed within the state we are holding the course; Pease click here to REGISTER.

First Name   Last Name                                
Degree    
Area(s) of Practice -  General  Perio  Pros  Oral Maxillo
Address   Suite 
City   State    Zip Code  
Phone    
Cellular   Email 

Fax

  Fee - Course fee is $3,650.00
(Payment In-Full is required prior to class)

Voucher ID#


       Team member Registration - $299.00 each -
  • Each Team Member will receive 10CE credits for attendance -
  • Team Members are free to attend the lecture days (one and two) - but mainly attendance for day three would offer them the best educational value. They will be watching how the office functions and partially assisting attending doctors with their surgeries.
      Name   
      Name   
Total Registration: Doctor & Team Members: $

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

Implant Mentoring - I,      $3,650.00
(Includes Meals and Supplies, 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. 

Seating is Limited and in High Demand - Seats will only be reserved for those individuals who register and pay in full for the course selected. Ladera Ranch Implant Institute will not hold unpaid seats

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 with the above stated Terms and Conditions
 

 
 

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