The Dental Shopper


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Questions or want to advertise? Email 2 January 27 – 28, 2017 FREE ADMISSION FREE C.E. COURSES Los Angeles Convention Center Last Name: First Name: E-mail: Business Name: Telephone (Business): Business Address: Telephone (Mobile): Address Line 2: Zip Code: State: Registration Status: ❑ Dentist ❑ Student ❑ Dental Assistant ❑ Dental Hygienist ❑ Staff ❑ Other _____________________ License #: Year of Graduation: Admission is free for the first 2000 registrants. Registration forms must be submitted prior to January 15, 2017. Proof of mailing might be requested for applications that reach us late. If you are registering for more than one person, use a separate form for each individual. All items above must be completed in order to process your application. Please print legibly and do not leave any blank spaces. ❑ Register me for the 2017 California Dental Expo and place me on your mailing list. ❑ I would like to receive special promotions, sale items, and product information from participating companies. * Instructions for selecting courses will be emailed to you. ✉️ Mail to: 2017 Registration, California Dental Expo, P.O. Box 49325, Los Angeles, CA 90049 Fax to: (310) 276-1295 (incoming mail only) Preliminary Registration Form

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