Registration Form Current Concepts in Removable and Implant Prosthodontics All dentists are welcome to participate in the course, and credit will count towards an AGD Fellowship and/or Mastership. The course contains 24 continuing education hours. DentistsAre you a member of the Oklahoma Academy of General Dentistry?*YesNoPlease enter the quantity of registrations you are purchasing below:Friday and Saturday Workshop — AGD Member Dentist Price: $1,750.00 Quantity: OAGD member dentists receive a $250 discount for the three day course (24 Continuing Education Hours).Friday and Saturday Workshop — Non-AGD Member Dentist Price: $2,000.00 Quantity: Open to all dentistsTotal Purchase $0.00 This is the amount you will be charged. You will receive an e-mail confirming your registration with details on date, time and requirements.About You This information will be used to process your payment and to enter your reservations for this workshop.Name or Practice*Please enter your name or the name of your dental practice.Attendees*IDFirst NameLast Name AGD members should enter their membership IDs. Enter the names of all the doctors you are paying for.Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Address of the person or practice paying for registration.Email* Phone*Credit Card* American ExpressDiscoverMasterCardVisaJCBMaestro Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name Subscribe to Oklahoma Academy of General Dentistry's E-mail List? Yes, I would like to subscribe Check here to receive electronic mailings from the Oklahoma Academy of General Dentistry.NoteQuestions, comments, need help. Leave a note. This iframe contains the logic required to handle Ajax powered Gravity Forms.