Treatment Coordinator Intensive Registration Next Course: March 17-18, 2023 Location: San Diego, California Tuition: $925 To finish your registration, please fill out the form below. Step 1 of 3 33% Your InformationFull Name PhoneEmail Doctor's Name 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* March 17-18, 2023 (San Diego) July 28-29, 2023 (San Diego) November 17 & 18, 2023 (San Diego) 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 AttendeesAttendeesNamePosition Click the (+) icon to add additional attendees. PaymentBilling Name First Last Billing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Attendee Price: Besides yourself, how many additional attendees will there be? Quantity Price: $0.00 Quantity (July)Besides yourself, how many additional attendees will there be? Quantity Price: $0.00 Quantity (March)Besides yourself, how many additional attendees will there be? Quantity Price: $0.00 Quantity (April)Coupon Total $0.00 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.CAPTCHANameThis field is for validation purposes and should be left unchanged.