Please register for your training here. This is a secured form and your information will be shared with no one else.

Registration Information* :

Where do you want to take the course?:  
Attendees must have proof of professional liability insurance that is current and in good standing
 Yes, I have professional liability insurance
Name:
 
Email Address:
 
Phone Number:
 
Fax Number:
 
Staff Participant’s:
 
Spouse/Guest Name (cocktail party)
Address:
 
City:
 
State:
 
Zip:
 
Type of lasers you own:
 Lasersmile Waterlase  MD
Other:
Magnification used:

Loupes Microscope None

Credit Card:
Visa Mastercard AMEX
  I understand that I am fully responsible for payment of tuition if no training funds are available. *REQUIRED
Credit Card Number:
 
Expires:
 
Name as it appears on credit card:
 
Questions & Comments :
 

*Course space will not be held without the above registration information.  Cancellation fees apply if cancellation is one week or less from seminar date, as there is limited course space available.  Tuition is $2995.00

Please fax registration to (406) 862-0613, and you will receive an email confirmation

For inquiries, please email lisa@waterlasetraining.com
 

Home   |   Schedule   |   Course Outline   |   Online Registration & Payment Options    |    DVD's

Site designed, hosted and maintained by Bella Web Design, Inc.