Andrews Philosophy Course

 SIX ELEMENTS™ 5-SEGMENT ORTHODONTIC PHILOSOPHY COURSE
REGISTRATION FORM  2009-2010

   

REGISTRATION FORM


COURSE DATES

#1  Feb 5, 6, 7, 2009         Six Elements™ Orthodontic Philosophy         San Diego, CA
#2  Apr 2, 3, 4, 2009         Preparing the Patient for Treatment                 San Diego, CA
#3  Jun 4, 5, 6, 2009          Diagnosis and Treatment Planning                   San Diego, CA
#4  Sep 17, 18, 19, 2009   Treatment Goals and Precision in                    San Diego, CA or
                                          Orthognathic Surgery                                     White Oak, PA
#5  Jan 14, 15, 16, 2010    Finishing to Element VI™                               San Diego, CA
                                          (Optimal Static and Functional Occlusion)



 

___I want to enroll in all 5 Segments (Orthodontists)- each segment $900
      Tuition: $4,500.
___I want to enroll in all 5 Segments (Part-time faculty, specialty residents)- each segment $600              Tuition: $3,000.
___I want to enroll in all 5 Segments (Full-time faculty, residents)- each segment $300
      Tuition: $1,500.
___ Occlusofacial Simulator™ starter kit $2,500.00
      *(required)                            

Tuition is due upon registration.  To enroll, please fill out and return the registration form page (or a copy), mark your calendar, and make hotel and travel arrangements. 
Payment:  Please send payment (by check in U.S. Funds payable on a U.S. Bank only, or use your Visa or MasterCard) to:

The Andrews Foundation            Tel. (800) 799-8952 (in USA only), (619) 224-0866           
2025 Chatsworth Blvd.               Fax.  (619) 224-6979   E-Mail:drandrews@msn.com
San Diego, CA  92107                Website: www.andrewsfoundation.org

_____Visa _____Mastercard. Acct. #________________________ Exp. date ______

Amount Enclosed $_____________________ Telephone no. (____)______________

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Name (Please Print)                      Dental School                                                                        Yr. of Grad.

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Signature Orthodontic School Yr. of Grad.

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Address

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City State Zip (Postal) Code

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Country

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Fax. no. E-mail address

___ I would like to include the price of the textbook “Straight Wire, The Concept and Appliance”.  The price of the book is $125.00(US) plus shipping and handling ($10 U.S., $20 Outside Continental U.S.). California Residents please add $7.75% sales tax ($9.69)



Cancellation Policy:  The Andrews Foundation reserves the right to cancel or postpone any course due to unforeseen circumstances or insufficient enrollment.  In the event of such cancellation, full tuition will be refunded.  For enrollees, there will be a full refund (less a $100 administration fee) for cancellations six weeks prior to the 1st Segment; there will be no refund or credit given if cancellation is less than six weeks prior to the course unless enrollee can locate a qualified replacement or the vacated spot can be filled from a course waiting list.  The Andrews Foundation assumes no responsibility for transportation or lodging.