Site sponsored by

  


Great Lakes Dental Seminars
945 E. Portage Ave.
Sault Ste. Marie, MI  49783
800-799-0033
info@greatlakesdentalseminars.com

 

 

 

 

Registration Form

Please print out this form and mail it with payment to the address below.  Unfortunately no credit cards are accepted.

 IMPORTANT :  A separate reservation form is required if you plan on staying at
the Grand Hotel at our reduced rates.  Click here to download and print their form  which must be mailed directly to the Grand Hotel.

Course:  Mackinac Island - August 2010


Name ___________________________

Name ___________________________

Name ___________________________

Name ___________________________

Name ___________________________

Name ___________________________

Address _________________________

City ____________________________

State ______    Zip code ____________

Telephone________________________

Fax _____________________________

Email ____________________________
 

 Register
Early
and
Save !!

Dentist Fee:  TBA
 
AFTER July 9th:
 TBA
   
******************

Auxiliary Fee:  TBA
  
AFTER July 9th:
 TBA

******************

8  Credit Hours

Dentist:     Qty ___  Amount $________
Auxiliary:   Qty ___  Amount $________

Total amount paid $____________________     

Mail to:   Oral Prosthetics by Design, Inc.
                945 E. Portage Ave.
                Sault Ste. Marie, MI  49783