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Visit My Dental Practice...

JamesKlim.com

WORKSHOP REGISTRATION

1. Complete and submit the registration form below.

2. Confirm registration and submit payment - our staff will contact you to confirm your registration details, send you an official invoice and finalize payment.

3. Attend the workshop and apply your learning to your practice.

REGISTRANT CONTACT INFORMATION:

Title:
First Name:
Last Name:
Address 1:
Address 2:
City:
State:
Zip:
Country:
Daytime Phone:
Evening Phone:
EMail:

WORKSHOP SELECTION:

Workshop::

Your Patterson Voucher Number (if applicable):

ADDITIONAL INFORMATION:

How long has your practice had CEREC?

And how many CEREC restorations completed?

How did you hear about CADStar and Dr. James Klim?

If your answer to the above was a referral, whom may we thank?