Approved Pace Program Provider
FAGD/MAGD Credit
4/2/2008 to 4/1/2011

Registration

Registration can be done by printing and mailing this registration form with a Money Order or Credit Card information to the following address 25606 Pecan Valled Circle, Spring, Texas, 77380 or you may FAX to 281-298-2412 .

Your registration will be acknowledged via e-mail or phone no later than 3 business days after the receipt of registration and payment. If you have not received confirmation within 5 business days please call 281-367-1951

Online registration is provided below. Please fill out the required information and submit. You will be directed to PayPal to complete the transaction. Credit cards and PayPal are accepted as payment with this method.

Primary Attendee Information:

First Name:
Last Name:
Address:
City:
State:
Zip:
Home phone:
Cell phone:
Email:
Employer:
Work Phone:

Check one: Dentist Assistant Hygienist Administrative Staff

Other Attendees

Number of Additional Attendees (0-9):

Name	Position

Course Information

	Course #	Date	Time	Location	Fee
	811	12/19/08	Same as above	Benco Dental Supply 2901 W. Sam Houston Pkwy Houston, TX 77043	$195.00

Cancellation/Refund Policy

A $25.00 per person non refundable administrative fee will be applied to all cancellations. Cancellations received within 10 business days prior to the seminar date will be eligible for a full refund minus the $25.00 per person administrative fee. To Cancel: Fax your desire to cancel to 281-298-2412

"NO SHOWS" will forfeit the full cost of the seminar. Only faxed cancellation notification will be accepted and the appropriate refund will be sent to the person and mailed to the address listed on the registration form. Please allow 15 business days to receive the refund check

This activity has been planned and implemented in accordance with the standards of the Academy of General Dentistry, Program Approval for Continuing Education (PACE) through the joint program provider approval of Dental Safety Compliance Serv. and Total Office Training Solutions. The Dental Safety Compliance Service is approved for awarding FAGD/MAGD credits.

I verify that I have read and fully understand all policies and procedures of Total Office Training Solutions.

Click the Submit button to be redirected to the PayPal payment page.

PayPal accepts credit and debit cards directly; registration is not required. To pay with credit or debit card instead of a PayPal account, please click the ‘Continue’ link at the lower left corner of the PayPal payment page.