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Password

At least 8 characters and at least 1 special character (e.g. @ ! ? € # ...)

Professional Custom Fields

Are you an AGD Member?

Yes

(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 #

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

THANK YOU!

An automatic confirmation email has been sent to the email address below. To complete your registration, please click on the link in the confirmation email.

THANK YOU!

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