$945 + tax = $1,086.51

First Name

Last Name

Cell Phone (to reach you on the day of event):

AGD # (AGD members only)

Help us improve please ... How did you hear about this offering? Who referred you?

Kindly type your name, as you wish for it to appear on your certificate:

DDS/DMD University?

Year of Graduation from Dental School?

I have read and agree to the terms and conditions of this page.

The BIOCLEAR Workshop - Sept 13, 2025 (Montreal, QC)