WCLI - Super Symposium 2010 Symposium Registration

Super Symposium 2010 Symposium Online Registration

To ensure your participation in the World Clinical Laser Institute's Super Symposium 2010 on March 5-7, 2010, please fill out the form below. If you any questions you may call Biolase directly at 800.699.9462.

* = indicates that you must enter valid information into that field.

Register Information

Please Select:

Titles (DDS,DMD,etc.):

Position:

Practice Name:

Special Food Request:

If you have been working with a Biolase Laser Specialist, please provide their name:

Laser Ownership

Do you own a laser?:

Yes

If yes, please list:

Referral

How did you hear about the Symposium?:

Sales

Mailer

Online

Other:

Tuition & Fees NOTES:
1.) Dollar amounts for Super Symposium is in US Dollars

Dentists:

($795.00 each)

Hygienists and Office Staff:

($595.00 each)

Social Passes for Guests:

($395.00 each)

Additional Attendees

1. Attendee Name:

2. Attendee Name:

3. Attendee Name:

4. Attendee Name:

5. Attendee Name:

6. Attendee Name:

Comments

Before continuing, please confirm that WCLI has permission to charge your credit card for the WCLI Symposium.

All information will be sent through a SECURED CONNECTION and to a SECURED SERVER. Please click the 'Submit' button below. The information will be sent to our registration staff, who will email or fax your confirmation form. Thank you for registering for the World Clinical Laser Institute's Super Symposium 2010.

By clicking submit you are verifying all information provided is accurate. You will be taken to the checkout and providing billing information authorizing WCLI to charge for your registration fees for the Symposium. *

HOTEL INFORMATION:
Super Syposium – special rate of $199 US dollars per night plus room tax and resort fee.

To make reservations by phone, call 800.228.9290 and ask for the special group rate of $199/room under Biolase/WCLI, code name Biobioi. Group rate ends on February 2, 2010. Your registration fee does not include hotel room or travel. Please book your room(s) directly with the San Diego Marriott Hotel and Marina. For more information contact us at Tel: 888.424.6527, Fax: 949.273.6687, Web: LearnLasers.com.

For more information contact Kimmarie Everett keverett@biolase.net Tel: 800.699.9462, Fax: 949.273.6687.

CANCELLATION/NO SHOW POLICY
Any cancellation after February 1, 2010, will incur an administration fee of $100.

CONFIDENTIALITY NOTICE:
The World Clinical Laser Institute respects your privacy. All information you provide using this response form will ONLY be used by the World Clinical Laser Institute in order to process the information you’ve submitted. Your personal information will NOT be sold, rented, bartered, or otherwise transferred to other people who would send you unsolicited mail. You may be included in photographs taken at the meeting that are utilized in Biolase media.