Dental Course Registration

Please fill out the form below. After we receive your registration information, you will be contacted for billing information to complete the registration transaction. A course confirmation letter, along with facility directions, will be mailed to you shortly thereafter. Please do not hesitate to call us at 800-854-0970 if you require additional information or do not receive the confirmation letter.

If you prefer, you may print a Registration Form (PDF) and fax it to us at 949-724-1740.

Registration Form

Reserve a seat at the following course:

Desired course date:

Offer Code:

Personal Information

Full Name:

Phone Number:

( )

Company Name:

Fax Number:

( )

Address:

Email Address:

City:

Glidewell Account #:

State:

Additional Staff #1:

Zip Code:

Additional Staff #2:

Comments / Questions:

Security Check:

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Enter Code:

Cancellation Policy

All cancellation requests must be in writing and faxed to 949-724-1740. Full refund of the course fee will be granted for cancellation requests postmarked seven (7) days or more prior to the scheduled course date. Fifty percent of the course fee will be refunded for cancellation requests received less than seven (7) days prior to the scheduled course date. The Glidewell International Technology Center reserves the right to cancel any course, limit enrollment, modify the announced content, or change the location, time, date, and faculty of any course, as the Glidewell International Technology Center may deem necessary or advisable. Should the Glidewell International Technology Center cancel a course, the Glidewell International Technology Center's liability is limited to a full refund of the course fee.

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Medical Device Excise Tax (MDET): Effective Jan. 1, 2013, some of our products will be subject to the 2.3% Medical Device Excise Tax. Learn more >>