Perio Institute Presents Perio Surgical Skills Workshop A 2-Day "Hands On" Workshop	AGD National Sponsor FAGD/MAGD Credit 1/1/93 - 12/31/02 Perio Institute, Inc. is an ADA C.E.R.P. recognized provider 16 Hours Continuing Education Credit Will Be Awarded
For dates and pricing go to the Course Schedule page.
Name_______________________________________________________ Address____________________________________________________ City_____________________ State______ Zip _________-_______ Phone______________________ Fax____________________________ Contact Person_____________________________________________ All amounts are in U.S. Funds Contact us for current pricing. ___ Enclosed is my check for the full amount. ___ Enclosed is my check for the deposit. Balance due 20 days prior to date of workshop Make checks payable to Perio Institute, Inc. ___ I wish to pay the full amount with my credit card. Amount Enclosed______________ If paying by credit card please provide the following: ** Visa, MasterCard and American Express are Accepted ** Credit Card____________________________ Exp______/________ Signature_________________________________________________	Mail To Perio Institute, Inc. P.O. Box 449 Union, WA 98592-0449 Register by Phone 800-327-3746 Register by FAX 360-898-7777
Cancellation Policy: 30% withheld if cancelled within 14 days of course date. No refund for non-attendance the day of the course. Any money withheld can be applied to any future course.

This page may be printed and Mailed or Faxed