Registration | East Coast Implant Institute

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Course Information

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Attendee Information

*Attendee Name:

*Degree

*Year of Graduation

*Office Name:

*Email Address:

*Phone:

Payment Information

*Payment Type - Amount: Deposit Only - $
Full Course Tuition - $

*Cardholder Name:

*Visa / Mastercard:

*Expiration (MM/YY)

*Security Code

Billing Information

*Street Address:

Street Address (line #2):

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Payment Confirmation

For Boston MaxiCourse - Only the $2000.00 deposit payment will be applied to the credit card provider upon registration. Payment plans must be discussed and arranged by emailing or calling. Option to pay in full is also available. Please contact us for details.

For NYC Mini Residency - Only the $1000.00 deposit payment will be applied to the credit card provider upon registration. Payment plans must be discussed and arranged by emailing or calling. Option to pay in full is also available. Please contact us for details.

For Zoom Webinars - The full cost of tuition for course is due at time of registration. There are no discounts applied for the webinar series.

Contact: Jana Selimovic, Program Coordinator
Email: education@bostonmaxicourse.com

Deposit is non-refundable

All other courses - The full course tuition will be applied to the credit card provider upon registration.

Payment Plan Requested

*I agree to pay the above Course Fee according to the card issuer agreement. Payment will be applied to the credit card provider upon registration. $2000 deposit is due at the time of registration.