Inland Empire Dental Society

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CE Course Registration

Tuition

Dentist (Members): $59

Dentist (Non-Members): $79

Hygienist/RDA (Members): $44

Hygienist/RDA (Non-Members): $54

Seminar:
Title:
First Name: *
Last Name: *
Member:	MemberNon-Member
Address:: *
City: *
State: *
Zip Code: *
Phone: *
Fax: *
Email: *
Referred by:
License Number: *
	Credit Card:
Name on Card: *
Card Type:	VisaAmexMasterDiscover
Card Number: *
Sec: *
Expiration: *	e.g (01/14)

If you would like to become a lifetime Member of the IEDS, please call

or email at i[email protected] for more info.

ONE TIME fee of only $29.

Cancellation policy: No refunds on cancellation, if cancelled 7 days prior to the seminar, a
one-time credit of amount payed will be transferred to future CE Class. NO REFUND OR CREDIT if cancelled within the 7 days of seminar.

Inland Empire Dental Society

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