Lecture Series Application

The CCADS Lecture Series provides a valuable opportunity for continual learning. To apply for a Lecture Series simply fill in the application form and we will contact you with the next steps. If you have any questions please do not hesitate to contact us:

*Please note that Dr. John Tran's Lecture Series in Calgary, Alberta is now full and will not be accepting new members. Thank you.

Phone: 1-877-457-9110
Fax: 604-688-9620
Email Us


Personal Information
Title:
First Name:*
Last Name:*
Gender:*
Age:*
Referral Name (If Applicable):
Email Address:*
Practice Name:
Practice Address:*
City:*
Province/State
Postal/Zip Code:*
Country:
Practice Phone:*
Practice Fax:
Cell Phone:
Practice Information
Owner of the Practice?*
Number of Years in Practice:*
Office Staff Information
Number of Full-Time Staff:
Number of Part-Time Staff:

Of the above how many are:
Dental Assistants
Hygienists
Billing/Office Staff
Other
Lecture Series

Select from existing Lecture Series areas or cities. If your area is not listed, please fill in "other" as we are constantly setting up new Lecture Series so will contact you when one is available in your area.

Other Location:

Read the Terms & Conditions
I Agree to the Terms & Conditions*

Once we receive your application we will review it and contact you with the next steps. Thank you.




Web Marketing Software By Marqui