Canadian Mexico Course Registration - AIE | Implant Continuing Education

Please fill out the form below to register for an AIE course and one of our representatives will get in touch with you shortly. This form is essential to custom tailoring our live surgery experience to your needs.

Full name*

Suffix*

Which course are you registering for?*

Chair Type*

What type of dentist are you?*

Dental license #*

Province of licensure*

Address*

Apartment/Suite

City*

Province*

Zip Code*

E-mail*

Confirm E-mail*

Office Phone Number*

Mobile Phone Number*

Approximate no. of hours implant surgical didactic CE completed*

Are you currently restoring implants?*

Have you attended a hands on surgical implant course before?*

Have you attended a live surgical course before?*

How many implants have you placed in the last year?*

What size scrubs do you wear?*

What scrubs type?*

What glove size do you wear?*

Latex Allergy?*

How did you hear about us?*

If you selected Other above, please specify.

Do you have any dietary restrictions? If yes, please describe.

If you selected Other above, please specify which techniques.

If you selected Other above, please specify which devices.

Once registered a representative will contact you for payment

Feel free to call +1-718-954-3525 for any questions regarding course registration.