Introductory One day orthodontic seminar: "Is ortho for me?"…………... $99

Fundamental Orthodontics-one year (4 session course)…………………$3,600

Intermediate Orthodontics-one year (4 session course)…………………$3,600
 students must have completed Fundamental Orthodontics to enroll.

Name______________________________________________________________

Address____________________________________________________________

City____________________________State______________Zip______________

Phone______________Fax_______________email_________________________

Send this form with check to:

IAO NE c/o Russell S. Chin, DDS
1288 Newport Ave.
Pawtucket, RI 02861

____$3,600 (4 session course)

____$99.00 one day informational session
        8:30 AM - 1:30 PM Sat, May 16, 2009, Windsor Locks, CT

OR Fax with credit card information to: 401-727-1488

CC # _ _ _ _ - _ _ _ _- _ _ _ _ - _ _ _ _ Exp. Date _____/_____