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Telefon klinik/firma

E-mail

Adgangskode

Mindst 8 tegn, store og små bogstaver samt mindst ét specialtegn (@ ! ? € # ...).

Bekræft adgangskode

Professionelle kundeområder

(Clinician) State of Licensure

Are you licensed in MA or VT?

Neither MA nor VT

Profession

Straumann customer number

State License Number

State of Licensure

Straumann customer #

NPI Number

State License #

Are you an AGD Member?

Yes

AGD Number

NPI #

As part of being a speaker or instructor for Straumann Group my email address will be displayed on assigned course registration pages as a means of contact for registrants and participants.

I agree.

Pursuant to VT Prescribed Products Law – Gift Ban: Straumann, as a medical device manufacturer is prohibited from providing meals to clinicians with an active VT dental license.

If I participate in a CE Course which includes a meal and I consume the meal I agree to be invoiced for the cost.

I confirm that I will not partake in any meals provided and I will make my own arrangements for food.

GDC Number

Allgemeine Geschäftsbedingungen (an der Fußzeile)

Akzeptiert

NTF Number

RPPS - France

Ma Profession

BIG-Nummer

First Name

TAK!

Der er sendt en automatisk e-mailbekræftelse til nedenstående e-mailadresse. For at gennemføre din registrering skal du klikke på linket i e-mailbekræftelsen.

Registrér

Professionelle kundeområder

Erhvervsregistrering

TAK!

TAK!