Register for Package B

Register B

Step 1 : Registration for SEASON 5 - Module 2 USD 4000

ATTENTION!!!

DUE TO COVID-19 THIS CLASS HAS BEEN POSTPONED UNTIL FURTHER NOTICE. PLEASE CHECK BACK WITH US BY JANUARY 2021. THANK YOU VERY MUCH.

Make sure you're entering your email address correctly since Bioprogressive CE team will use the email address to communicate and provide an update to you.

REGISTRATION FOR SEASON 5 (2020) - MODULE 2 CURRENTLY CLOSED.

METHODS OF PAYMENT

MASTER / VISA THROUGH PAYPAL (5% TRANSACTION CHARGE MIGHT APPLIED) OR

WIRE TRANSFER TO FOUNDATION FOR MODERN BIOPROGRESSIVE ORTHODONTICS ATTN : ADAM POLLACK (NO TRANSACTION FEE)

ACCOUNT NUMBER : 7529276920 WIRING ROUTING : 121000248

FOR DIRECT DEPOSIT USE ROUTING NUMBER : 102000076

SWIFT CODE : WFBIUS6SDEN

Step 1 : Registration for SEASON 5 (2020) - Module 2 USD 4000

Salutation

Your salutation / title such as Dr. Prof.

First Name

Your first name, exclude title or salutation

Last Name

Your last name (and middle name)

Email Address

Please provide VALID email address for sending any updates on CE

Street Address

City

State

Country

Zip Code

Home PH

Home Phone (please include country code and area code)

Cellular PH

Cellular Phone (please include country code and area code)

Work PH

Work Phone (please include country code and area code)

Graduation Date from Orthodontic Graduate

Graduation Date from Orthodontic Graduate Training Program (or expected graduation date)