Summit Dental Study Group


		"Living in a Virtual World and Other Ramblings through a Cluttered Mind"

		Steve Ratcliff, DDS, MS - Thursday, April 15, 2010 3 hours CE credit

To register for this program, please enter the following information:

I am interested in:

Select One:
	Doctor	$295
	Staff/Aux (with paying Doctor, $149 otherwise)	$ 99
	Student	FREE

Name:

Clinic:

Street Address:

Mailing Address: (if different)

City:

State:

Zip Code:

Email: (for program reminder)

AGD #: (if you would like us to submit your credits)

Phone:

Fax:

Preferred Method of Payment:*

Comments: (Include additional attendee names.)

* A Summit Dental Study Group associate will contact you shortly.