April 18-19, 2008
Registration Page
"Discover the Amazing Secrets of Using a Patient Care Coordinator in YOUR Practice"
Course Fees, E-Mail, Payment, Registration, Cancellation Policy, Hotel Info 

Course Fees

bullet Seminar Price: $2580.  Includes doctor's registration, wine/cheese, breakfasts (2),  lunches (2), Friday night dinner, and supplemental materials. (Doctor's spouse will be given a complimentary ticket with doctor's registration. This is only to encourage "nondental" spouses to attend and does not transfer to a team member.)  If doctor doesn't attend, the first team member will register at this price.
bullet Additional Team Members: $620.
bullet *Note: Early bird discount available through March 7, 2008.

Registration
To register for a workshop, please fill out the form below and click "submit."
Payment form is below registration form.

Registration
"Discover the Amazing Secrets of Using a Patient Care Coordinator in YOUR Practice"
April 18-19, 2008

Course Name:

Doctor's Name ($2580/$2280):

First Team Member if doctor does not register ($2580/$2280):

Spouse's Name (Included with Doctor):

Name of Team Member #1 ($620/$570):

Name of Team Member #2 ($620/570):

Name of Team Member #3 ($620$570):

Name of Team Member #4 ($620/$570):

Name of Team Member #5 ($620$570):

Your Practice Name:

Your Office Street Address:

City, State, ZIP, Country

Office Phone:

Office Fax:

E-mail Address for Workshop Correspondence:

Total Amount Owed:

How will you pay? By PayPals or by mailing a check?


 

 

Thank you for your registration.  Once registration is received, you will be added to the waiting list.  Receipt of payment will move you to the "confirmed" list as long as space is available.  Remember, space is LIMITED, so send your payment as soon as possible.  A confirmation will be e-mailed to you when registration and payment are received. 

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Payment Information

If you prefer to pay by check there is no credit fee.  Make your check payable to "With Splash" and mail it to:

With Splash
c/o Melinda Coker
P.O. Box 8423
Tyler, TX 75711

If you prefer to pay by credit card, you must pay through the secure PayPal site by using the form below.  If you have ever used PayPal before, they will want your e-mail and password and credit card to match. However, you can also check the box that says, "Don't have a PayPal account?" and go from there. 

Once you have gotten your card submitted, you will receive an e-mail directly from PayPal regarding your charges.

"Early Bird" Charges are Below the regular charges on the form below.  Just be aware of "Early Bird" deadlines.

Doctor attending "Discover Amazing Secrets of PCC" (or 1st team member): AFTER March 7th: $2,580.00 + $60 Credit Fee

Team Member attending "Discover Amazing Secrets of PCC" (with doctor or 1st team member): AFTER March 7th: $620.00 + $15 Credit Fee

Doctor attending "Discover Amazing Secrets of PCC" (or 1st team member): EARLY BIRD: Good Through March 7th: $2,280.00 + $60 credit fee

Team Member attending "Discover Amazing Secrets of PCC" (with doctor or 1st team member): EARLY BIRD: Good Through March 7th: $560.00 + $15 credit fee

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"Notes" from the PayPal Customer Service Website in case you have forgotten your PayPal password or have other problems: 

PayPal Customer Service Agents are available to help you from 4:00 AM PST to 10:00 PM PST every day.

Call us toll-free at: 1-888-221-1161

We may only discuss an account with the account-holder. Please have the following information available when you call:
bullet Your telephone number
bullet Your email address
bullet The last 4 digits of your credit card or bank account registered with PayPal
bullet For security reasons, we must verify the above details before discussing any account-specific information.

There may be a $2,000 limit for any person who has not used PayPal before until they can verify your bank account.  If you plan to use them, please don't wait until the last minute as they will not hurry.  :-(

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Hotel and Transportation Policy

Visit the HOTEL INFORMATION page.

 

Cancellation Policy

Cancellation requests must be received before 5PM on September 7, 2007 for a full refund.  Cancellations received on April 8th or later will be subject to a $150 administrative fee. 

E-Mail

If you have any questions, please e-mail Melinda Coker at: melinda@withsplash.com

General Information About Our Workshops

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