2011 Registration Form
Each course date listed below will be a one-day lecture and participation course including skulls, models and instruments. Each class will be limited to 20 dentists. Gunnar Philipp, developer of the Ögram System, will be the speaker.
To attend an upcoming course, please fill out the registration form below to register electronically or register by fax or phone. Tuition payment can be made by check, Visa or MC.
Payment by check: submit a deposit of $350.00 for each dentist attending with the balance due payable by check at the course; or submit the full tuition amount. We must receive your check within 7 business days after your registration. Please include a copy of your registration form along with the check.
Payment by credit card: call our office with the credit card information (940-382-8922).
Written confirmation, with course location, will be mailed to you shortly after receipt of your registration and payment. Please call our office with any questions.
Doctor Tuition: $585
Chairside Assistant/Auxiliary: $125 (highly recommended)
Audit Fee: $395 (only for dentists who have previously attended our course)
Registration: 8:00 am to 8:30 am
Course time: 8:30 a.m. to 5:30 p.m. (course time 8 hours-participation)
Lunch is included
8 Hours Participation CE; Advanced PACE Program Provider: FAGD/MAGD Credit; State CE*; The Ögram Course CE Certificate; Course Syllabus
Please provide the following contact information: Hit the Tab button to skip to the next field.
Your Name Title Organization Street Address Address (cont.) City State/Province Zip/Postal Code Country Work Phone FAX E-mail
Choose one of the following Dates and Locations: Jun 03 2011 Milwaukee, WI Jun 04 2011 Minneapolis, MN Jun 10 2011 Baltimore, MD Jun 11 2011 Philadelphia, PA Jun 17 2011 Dallas, TX Jul 15 2011 Lubbock, TX Jul 16 2011 Amarillo, TX Jul 23 2011 Little Rock, AR Aug 19 2011 Tulsa, OK Aug 27 2011 Seattle, WA Aug 26 2011 Portland, OR Sept 16 2011 New York, NY Sept 17 2011 Boston, MA Sept 23 2011 Phoenix, AZ Sept 24 2011 Denver, CO Oct 07 2011 Chicago, IL Oct 08 2011 Detroit, MI Oct 21 2011 Baltimore, MD Oct 22 2011 Richmond, VA Nov 04 2011 Columbus, OH Nov 05 2011 Atlanta, GA Nov 18 2011 San Diego, CA Nov 19 2011 Los Angeles, CA Dec 02 2011 Orlando, FL Dec 03 2011 Miami, FL Dec 09 2011 Dallas, TX Dec 10 2011 Fort Worth, TX
Attendees: Choose one of the following options:
Doctors Name: First Time Taking The Course Audit/Refresher
Auxiliary Name:
* State CE where applicable Refunds: All tuition paid will be refunded in full should we cancel the course you have scheduled. Participants cancellations or no shows are not refundable, however, tuition payments made will be applied toward our future course dates in the U.S.A.