$1,495 + tax = $1,718.88

First Name

Last Name

Cell Phone (to reach you on the day of event):

AGD # (AGD members only)

Help us improve please ... How did you hear about this offering? Who referred you?

Kindly type your name, as you wish for it to appear on your certificate:

Year of Graduation?

I have read and agree to the terms and conditions of this page.

CBCT Small ONLY - Oct 26-27, 2024 (PAY IN FULL)

Looking forward to learning & sharing together :)