Register - Expert Dental Solutions

APPLY AND SECURE YOUR SPOT!

Name^*

Email ^*

Confirm Email^*

Mobile Phone^*

Name for Certificate^*

AGD Number (If applicable)

Medical Conditions to Be Aware Of^*

Enter Emergency Contact Phone^*

Specialty^*

How Many Years Have You Been in Practice?^*

What is your surgical experience level?^*

Food Allergies or Dietary Restriction^*

White Coat Size^*

How Did You Hear About the Course?^*

*Referral name cannot be changed after registration.

Courses and Tuition^*

Promo/Referral Code^*

I understand that travel to and from Rio de Janeiro, Brazil is my responsibility.
I understand that transportation between the airport and the hotel (round trip) and between the hotel and the university (daily round trip) is provided by Expert Dental Solutions.
I understand that a four-star hotel with breakfast is provided by Expert Dental Solutions.
I understand that depending on my nationality, I may need a visa.
I understand that travel health insurance is highly recommended.
Refunds are available for cancellations made 45 days prior to the course. All cancellations are subject to a non-refundable administrative fee of $1,200. Cancellations made less than 45 days before the course start date are non-refundable.

I confirm that I have read, understand, and agree to the Terms and Conditions of the course, including the cancellation and refund policy.

Date

Signature^*

ATTACH PASSPORT * PDF | JPG | JPEG | PNG^*

ATTACH DENTAL LICENCE * PDF | JPG | JPEG | PNG^*