School of Dentistry

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Register for Continuing Education Classes

To register for the CDE courses, please fill out all the fields below. Required fields are bolded. The form will not be processed if these fields are left blank. At present, we cannot take credit card payments online. After submitting the form. call 503-494-8857 or 800-232-6478 to make a VISA or MasterCard payment

Course Title:
	Title of the course which is being registered for.
Course Date:
	Date of the course which is being registered for.
First Name:
	First name of person registering.
Middle Initial:
	Middle Initial of person registering.
Last Name:
	Last name of person registering.
Email Address:
	Email address of person registering.
Degree:
	Degree held by person registering.
Office Phone:
	Office phone number of person registering.
Home Phone:
	Home phone of person registering.
Address:
	Mailing address of person registering.
City:
	City in which person registering lives.
State:
	State in which person registering lives.
Zipcode +4:
	Zipcode of person registering.
Firm:
	Firm with whom person registering is associated.
Cost:
	Price of the course for which person is registering.
Reason for discount (if any):
	Potential reason person who is registering may have for receiving a discount on the course.

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School of Dentistry

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Register for Continuing Education Classes

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