Pre-Registration Form
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You must pre-register.
Please fill in the this form with the requested information. There will be no confirmation given. On the night of the first class a Registration Form will be completed and you will be expected to pay all course charges and fees by check, Master Card or Visa.
Courses may be taken for 3 graduate credits from Worcester State College for $550 Courses may be taken for 30 PDPs for $450
Pre-registration will not be confirmed. If a course is cancelled, I will contact you.
| Name | |
| Position | |
| School | |
| Work Phone | |
| Home Phone | |
Please check this box, if you are NOT on the Denty Connection Mailing List?
Address
Questions or Comments:
Please select a course from the following list. Use the down arrow to find the course and highlight it. Please make sure you have the correct starting date. When you are finished please click on Submit Form.
| Course Name |
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