Step 1 of 3 33% Your InformationFull Name PhoneEmail Practice Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Is your practice part of a DSO (Dental Service Organization)? Yes No Select Date November 13 & 14, 2020 March 19 & 20, 2021 July 23 & 24, 2021 Are you a Mari's List member? Yes No Are you an Elite Dental Alliance member? Yes No Elite Dental Alliance Member # Whom may we thank for referring you to our Workshop? Mailer Internet Other Please Specify AttendeesAttendees*NamePosition Click the (+) icon to add additional attendees.HiddenTotal Number of Attendees (Auto-Populated)Attendee Price: Price Calculation Price: $825.00 Total $0.00 PaymentBilling Name First Last Billing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Tuition Policy: The tuition is nonrefundable 30 days prior to the Workshop. However, tuition may be transferred to the next available Workshop for a fee of $250.00. Upon clicking "Submit," you will be taken to Paypal to complete your payment.CAPTCHA