Foundation Implant Training
Tijuana Live Surgical Course Registration
Attendee Information
Name
*
First Name
Last Name
Preferred Name
E-mail
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this address the same as your billing address?
*
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Birth Date
*
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Day
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Year
Which hand is your favorite?
Please Select
I am right handed
I am left handed
Dental Information
Dental License Number
*
State of Dental License
*
Owner or Associate
Please Select
Practice Owner
Associate Dentist
Dental Practice Name
Practice Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this address the same as your billing address?
*
Yes
No
Practice Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
State Dental License
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Dental Malpractice Certificate of Liability
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Travel Information
What Airport Will You Be Flying to SAN From?
Is Your Passport Active?
Yes
No
Does Your Passport Expire Within 1 Month of the Planned Course?
*
Yes
No
Upload Picture of Passport
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Have you taken any implant courses in the past? If so, which one(s)?
whether it was an online, lecture only, hands-on live patient course, etc
I have placed this many dental implants
Please Select
1-10
10-25
25-50
50 or more
What implant system (if any) are you currently using?
What are the goals that you are wanting to achieve by taking this course? (answer this as thoroughly as you can so that we can address all of your objectives)
Any special considerations needed? (i.e. Food Allergies, Learning Disabilities, etc)
How did you hear about F.I.T.?
Payment
Which Course Date Would You Like To Attend
*
August 18, 2026 - August 23, 2026
By checking this box, you acknowledge and agree to the cancellation policy: Cancellations made more than 31 days prior to the scheduled course date are eligible for a full refund or can put toward a future course date. Cancellations made within 31 days of the course date will incur a non-refundable fee of $5,000. If you reschedule your registration and subsequently cancel, the $5,000 non-refundable fee will still apply, regardless of when the cancellation occurs.
*
Yes, I Agree
Course Tuition
*
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( X )
Foundation Implantology Course
$14,750.00
$
14,750.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
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