2012 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: $595
Chairside Assistant/Auxiliary: $125 (highly recommended)
Audit Fee: $395 (only for dentists who have previously attended our course, includes full CE credit.)
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: Mar 02 2012 Indianapolis, IN. Mar 03 2012 Columbus, OH. Mar 09 2012 Anaheim, CA. Mar 10 2012 San Diego, CA. Apr 13 2012 Raleigh, NC. Apr 14 2012 Atlanta, GA. Apr 20 2012 San Francisco, CA. Apr 21 2012 Denver, CO. May 11 2012 Chicago, IL. May 12 2012 Milwaukee, WI May 18 2012 Baltimore, MD May 19 2012 Philadelphia, PA Jun 08 2012 New York, NY Jun 09 2012 Newark, NJ Jun 15 2012 St. Louis, MO. Jun 16 2012 Minneapolis, MN. Jun 22 2012 Dallas, 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.