Registration - Eliminating Sensitivity, Mineral Rebalancing & Optimizing Fluoride Uptake - Gregor Connell

Click here if your form does not load properly
Eliminating Sensitivity, Mineral Rebalancing & Optimizing Fluoride Uptake

3 CE EVENT - November 1, 2024 - Louisville, KY
Practice Name*
First Name*
Last Name*
Email*
example@example.com
Please Note

If multiple people are registering from the same office, you MUST use a unique email address for each. This is how you will receive your CE verification
Street Address 1*
Street Address 2
City*
State/Province*
Postal/Zip Code*
Title*
Specialty
AGD Number
If you are an AGD member, please enter your 6-digit AGD number
Phone Number*

Area CodePhone Number
Patterson Account Number
If you are a Patterson customer, please enter your account number. Your Patterson account number can be found on Patterson invoices and statements.
Special Requests
Please list any special requests such as food allergies.
By clicking Submit, you acknowledge and agree that Patterson may process your personal information as detailed in our Privacy Notice.
Should be Empty:

Eliminating Sensitivity, Mineral Rebalancing & Optimizing Fluoride Uptake