Clone of CO2 Dental Hygiene - Denver

Name

First NameLast Name

•• NOTE: Each attendee must register separately. ••

Degree

Name of Dental Practice

Practice Focus

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Confirmation Email

Cell Phone

Are you an existing customer?

Which lasers do you use? (Select all that you use.)

Are you joining us for dinner at Meehan's Chophouse the night before?

NOTE: Lunch will be provided during this course. If you have any food allergies, please email klane@dekadentallasers.com

April 18 (Sat) - Mansfield, TX$995.00

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