Seminar Location Desired

TUITION  
1st Attendee
$495
2nd Attendee
(immediate family and office members only)
$295
Each Additional Attendee (immediate family and office members only)
$195

Refresher Fee
(for previous attendees*)
$245

*Please note location and date

Student Fee
$195

*Please list Dental College

Architects, design professionals and equipment suppliers
$995
TOTAL AMOUNT DUE
All expenses for Continuing Education including tuition, travel, meals and lodging are tax deductible.
Participant Names (for name tags)

Cancellation Policy:
Full refund will be made if cancellation is received at least 14 days prior to seminar date. A $100 handling fee per person for late cancellations. No refunds on or after the seminar date.

Fees effective 1/1/12
From the Office of Doctor
DDS  DMD   Specialty:
Address
City    State    Zip
Phone
E-mail

Fax

Billing Address (if different than mailing address)
Address
City    State    Zip
Method of Payment:
Check (Payable to Designing Solutions Seminar)    
MasterCard   Visa  
American Express   Discover
Card Number

Expiration Date

3 Digit Security Code (CIV) from back of card

____________________________________________
Authorized Signature
3 Easy Ways to Register:
Phone 402-423-3300 or
Fax your registration to 402-423-3377 or
Mail registration to:
UNTHANK DESIGN GROUP
Designing Solutions Seminars
5930 VanDervoort Drive, Suite B
Lincoln, NE 68516