To register, please complete and post mail to |
Doctor’s Name |
Course Fee | ||
| 1. | |||
| Hygienist’s Name | |||
| 1 | |||
| 2 | |||
| 3 | |||
| Assistant & Office Staff Name | |||
| 1 | |||
| Assistant & Office Staff Name | |||
| 1. | |||
Total. |
$ | ||
| Waterlase & Diode Tuition $1295.00* per D.D.S. or R.D.H. $700.00* per Clinical or Admin. |
Diode Course Tuition |
|
Advanced Laser Technique and Application Course |
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Enclosed is my check for $_________________ made payable to: Gloria E. Monzon, R.D.H.
No credit cards, please. Please mail to: 684 Princess Place Milpitas, Ca 95035
Doctor/Co. Name |
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| Address | |
| City, State & Zip | |
| Daytime Phone | |
| Evening Phone | |
| Fax & Email | |
| Your Laser Model | |
| Desired Course Date |
Minimum class size is 8 attendees and maximum of 25. Class size is limited. Early registration is strongly recommended. Your payment secures the requested class date. Cancellation within 14 days of seminar, are accommodated with a one time transfer of deposit to a future seminar. Advanced Laser Hygiene Phone & Fax: (408) 262-8780 Email: laserglo@comcast.net |