Animal Dental Training Center
Online Registration Form

Animal Dental Training Center Logo

*Problems or Questions with course registration? Please Email Us
or call our office at 410-828-1001 so we can help!

Course
Information
* Course Date and Name
WAITLIST HELP

The waitlist button should only be used if the course you wish to register for is marked as FULL or has been listed as TBA [date to be announced] when you click on it. Clicking on this box will prompt you for basic contact information and only guarantees you priority should space in a course become available.
Waitlist
Please Add Me To The Waitlist
Personal
Information
* Hospital Name
* Name of Attendee
Name of Attendee2
Name of Attendee3
Name of Attendee4
Mailing
Address
* Address 1:
Address 2:
* City:
* State/Province:
* Country:
* Zip Code: -
* Phone
Ex. 414-141-4141
Fax
Ex. 414-141-4141
* Email Address
-- Course Receipt & Confirmation Is Sent Here
* Verify Email Address
* HOW DID YOU HEAR
ABOUT THE CENTER?
Billing
Information
* Credit Card Type
MasterCard Visa
* Name On Card
* Credit Card Number
Ex. 1234-5678-9012-3456
* Expiration Date
Ex. mm-yy
CVV2 HELP

For Visa and Mastercard the Card Security code is a 3 digit code printed on the signature strip on the back of the credit card. The value does not appear on the front of the card. The value will be the last 3 digits of the printed number at the top of the signature strip.
* CVV2 Number
3-digit card security code
Billing
Address
Use Mailing Address Above
*Address 1:
Address 2:
*City:
*State/Province:
*Country:
*Zip Code:
-
Confirm Total Amount
USD
PROMO CODE
Additional
Comments
* Terms & Policy


I understand and accept the terms and policy stated above *
Email Newsletter
I would like to receive information on upcoming courses, special ADTC events, and pertinent educational articles through our email newsletters.

*Problems with the registration form? Please Email Us or call our office at 410-828-1001 so we can help!

Please make sure all information above is complete and correct before pushing Submit.
You will be able to print a copy of this information for your records on the next screen.
* Required Fields
CLOSE X
Class Waitlist / TBA Signup Form

Thank you for your interest in the Animal Dental Training Center's (ADTC) intensive "hands-on" courses. By submitting this form, you will ensure we are able to contact you first with any course availability information should there be a cancellation. If a course date has not yet been announced [TBA], this form allows us to gauge interest and contact those who sign up first, before general registration begins, to reserve a spot in the course.

Select the course you are interested in below and fill out the form completely with all * required fields. If you have any special comments / questions / requests please also include these under the "additional notes" section. This panel may be closed by clicking on the close link in the upper-right corner.

* Course Date
and Name
Personal Information
 
* Hospital Name
* Contact Name
* # of Attendees

   
* Phone Ex. 414-141-4141
Fax Ex. 414-141-4141
* Email Address Required For Notification Purposes
* Verify Email Address Ex. user@somewhere.com
   
* HOW DID YOU HEAR ABOUT THE CENTER
Additional
Notes
* Required Fields     
CLOSE X
Special Class Registration

PLEASE NOTE: As this is a special registration, you should only be selecting a course below if you have been given pre-approval to enroll this way. Only classes currently listing as "full" are shown below, and therefore any other sections should be selected by closing this panel and registering normally.

No courses available for special registration at this time.
No Other Courses Presently Listed