Seminar Registration Form
Please join us to learn more about effective claims submission. Include the names of all staff members who plan to attend. Indicate your choice of seminar dates.
License #
Dentist's name
Address
City
State Zip -
Phone number - -
Dentist(s) attending
Staff attending
Which session(s) will you attend?
ECS session only (half day) Claims processing session only (half day) Both sessions (full day)
Date/location of the seminar March 10, San Jose July 21, Norwalk
Your e-mail address
Check this box if you see Denti-Cal patients.
Name of your Practice Management System (software)
