Fall 2026 Mastertrack/Fellowtrack Course Registration - Iowa Academy of General Dentistry

First Name *

Last Name *

Email *

Cell Phone *

Used for text confirmations and communications for the event.

Mailing Address *

Address

City

State / Province / Region

Zip / Postal Code

Are you an active member of the Academy of General Dentistry (AGD)? *

Yes
No

We now offer a 25% discount for recently graduated dentists up to their 5th year post-graduation! Are you dentist who recently graduated from dental school between 2021 - 2026? *

Yes
No

What is your AGD Member ID#? *

Would you like to become a member of the AGD to take advantage of exclusive offers and discounts on AGD courses and events? *

Yes
No

Please complete the AGD membership registration here: https://www.agd.org/membership

Which day(s) will you be attending? *

Friday - Lecture Only
Friday Lecture & Saturday Hands-On

Select one. *

Dentists - $ 399.00
Clinical Staff - $ 125.00
Lab Techs - $ 175.00
Dental Students - $ 35.00

Select one. *

Dentists - $ 499.00
Clinical Staff - $ 125.00
Lab Techs - $ 175.00
Dental Students - $ 35.00

Select one. *

Dentists - $ 849.00
Clinical Staff - $ 125.00
Lab Techs - $ 175.00
Dental Students - $ 49.00

DDS may bring a clinical staff member to assist during the Saturday Hands-On Course. Since you have selected to attend the Hands-On portion of the course for Saturday, will you be bringing a Clinical Staff member to assist you? *

Yes
No

Staff Member First Name *

Staff Member Last Name *

Staff Member License Type *

RDA - Registered Dental Assistant
RDH - Registered Dental Hygienist

Staff Member License # *

Clinical Staff Member *

Fee - $ 125.00

Total *

360.00

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