Join us at our next class:
August 28-29, 2009
Griffin, GA


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		"I’m honored that you’ve decided to register. You won’t be disappointed, I guarantee it.”

Registration

We appreciate your interest in attending Endo Root Camp^®. Please fill out and confirm the information below. If you have any questions, please contact us at (877) 478-9748.

$2197 - Doctor Tuition; bring team for just $497 each. AGD members save 5%!

I. Select Date and Location


	August 28-29, 2009 Griffin, GA
	October 16-17, 2009 Las Vegas
	November 13-14, 2009 Griffin, GA
	December 11-12, 2009 Griffin, GA
	January 22-23, 2010 Las Vegas
	February 19-20, 2010 Griffin, GA


II. Personnel Attending


	Number of Dentists

	Number of Team Members

III. Registration Information

First Name

Last Name

Title

Practice

Address

City

State

Zip Code

Office Phone

Fax

Email

IV. Billing Information

AGD Member #

AGD members receive a 5% discount!

Billing Name and Address Same as Above.

Name

Address

City

State

Zip Code


V. Confirm Your Information

9501 Hillwood Drive, Las Vegas, NV 89134

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