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CE Registration Form

Please fill out the form below to register for any of our classes. CPR classes fill early so contact our office by email or phone to reserve your spot in our 2 sessions this year.  Be aware that we will be confirming your registration by email.  This alone will save hundreds of trees! 

Register

Your name:
Position: (RDA, front staff, etc.)
Dr/RDA/RDH License Number (if applicable):
Your Email:
Dr's Office:
Dr's Phone:
Dr's Email:
Registering for:
2/23/11 Oral Hygiene & Ortho. 12:30-2pm
6/15/11: Diode Lasers. 12:30-2pm. 
9/14/11: Orthodontics 202: 12:30-2pm
12/1/11: Holiday Party.

As always, our CE courses are complimentary, however this year we are requesting  a $5 tax-deductible donation per participant to be donated to your choice of 3 local children's charities.  This year our beneficiaries include: Kathy's Camp for Kids, Girls on the Run-Sonoma County, and makesomeonesmile.org, a local charity devoted to offering dental care to low-income children.