Registration - London, ON Dentist

1295 HIGHBURY AVENUE, UNIT C8, LONDON, ONTARIO, CANADA, N5Y 5L3 - Call Toll Free 1-877-372-7625

Approved PACE Program Provider FAGD/MAGD Credit
Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement 1/2008 to 2/28/2012

To register online, please submit your information:

Doctor's Name		DDS DMD
Staff Name(s)
Address
City	Province/State	Zip/Postal Code
Country
Practice Phone ( ) -	Other Phone ( ) -
Fax ( ) -	Email

Please select a location:
To book your reservation with the hotel online, please click on the hotel name and you will be directed to the hotel web site.

Course
Location

Please select your payment method:
Your registration will be processed upon receipt of payment.

Credit card payment by fax. Please print off this fax payment form for payment submission.

Please call me for payment information.

Comments:

Plus taxes where applicable. Refund and cancellation policy in effect. Prices, dates and locations subject to change without notice.