Course RegistrationPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Dental Practice Website / URLPhone *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAvailable Items *Dentist - $799.00Dentist (Day 1 Only) - $699.00Dentist (Day 2 Only) - $699.00Physician - $799.00Physician (Day 1 Only) - $699.00Physician (Day 2 Only) - $699.00Staff - $395.00TUSDM Faculty - $395.00TUSDM Alumni - $395.00Students, Interns, Residents and Fellows - $195.00DMD Student - $0.00Post-grad Student - $0.00Tufts DMD Student (Day 1 Only) - $0.00Tufts DMD Student (Day 2 Only) - $0.00Coupon Apply Total Amount$0.00Stripe Credit Card *Submit