2025 Flagship Course REGISTRATION

2025 Flagship Course

Dentists & Practice Owners
Name*

First NameLast Name
Email*
example@example.com
Office Name*
Office Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Office Phone*
Please enter a valid phone number.
Doctors Cell Phone*
Please enter a valid phone number.
Men's Jacket Size (Dentist/Associate)*
Women's Jacket Size (Dentist/Associate)*
Associate Doctor Name

First NameLast Name
Men's Jacket Size (Dentist/Associate)
Women's Jacket Size (Dentist/Associate)
Accompanying Staff Name and Position

First NameLast NamePosition
Accompanying Staff Cell Phone Number
Please enter a valid phone number.
Accompanying Staff Name and Position

First NameLast NamePosition
Accompanying Staff Cell Phone Number
Please enter a valid phone number.
Do you or your team members have any dietary restrictions or allergies?*
Please select course date*

November 3-6th, 2025

*A $5,000 Deposit is required

The deposit is NON-REFUNDABLE, it can be transferred to a different date or course type but is not refundable. *as of May 1, 2025 a 3% surcharge will be applied to all credit card transactions and does not include debit cards.

My Products*

Full Tuition - 1 DoctorFlagship Course

$9,995.00

Team MembersPer Team Member.

$2,500.00 Quantity

Associate Doctor (attending with practice owner)

$4,995.00 Quantity

Enter coupon

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please verify that you are human*
Should be Empty: