Name:

Degree(s): Years in Practice: Specialty:

Address:

City: Country: State:

Zip: Telephone: Fax:

E-mail Address:

Includes:

• Coach class airfare
• Up to 4 nights at the hotel
• 20 implants to place and/or keep
• All grafting material used. Loaner implant motors, surgical kits and
  handpieces
• Faculty Supervision. 30 CE credit hours approved by Academy of
  General Dentistry, and by the American Dental Implant Association
  towards Fellow and Masterships.
• Breakfasts, tips and hotel taxes included. Transportation to and from:
  airport, hotel and the institute. Daily lunches at the institute