Close Browser Window to Return to Phasing Out
Use the Print function on your browser to print out a copy of this page. Complete the following information and either mail or fax the form to address at right.

PHASING OUT SEMINARS
2728C Westmoor Ct SW
Olympia, WA 98502

FAX TO: 306.754.1098

You may also call us directly with your reservation, at 1.877.428.5837.

Seminar Location: Seminar Date:  
I would like to attend:     [  ] Basic     [  ] Advanced     [  ] Both
Your Name(s):  
Additional Attendee(s):  

 

Your Street Address: Apt. or Suite:  
Additional Address Info:  
City: State: Zip:  
Your E-mail Address:  
Your Phone Number:  
Your Fax Number:  
Special Instructions
or Questions?
 
TUITION INFORMATION
Basic Seminar (morning) Tuition - $499 per dentist
Advanced Seminar (afternoon) Tuition - $499 per dentist
Basic & Advanced Seminars Tuition - $899
Additional attendees - $499 each
Blueprint alone - $695
      [  ] Check Enclosed payable in US funds to "Phasing Out"
Charge my:     [  ] Visa     [  ] MasterCard
Card Number:  
Expiration Date:  
Signature:  
[  ] I'm interested in the Individual Consultation     [  ] I'm interested in purchasing the Contract Blueprint