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Welcome to Registration

Select your course location and date:

East Coast- Newark Marriott Airport Hotel

2006
2007
Level 1 Feb 17-18
Level 2 March 24-25
Level 3 April 21-22
Level 4 May 19-20

To Be Announced

West Coast - Los Angeles LAX Marriott hotel

2006
2007
Level 1 Sept 15-16
Level 2 Oct 13-14
Level 3 Nov 10-11
Level 4 Dec 8-9
To Be Announced
London United Kingdom 2006

Level 1&2 June 7-10 2006
Level 3&4 September 27-30 2006

Mumbai,  India-To be Announced

 

Please print clearly.

Name________________________________________________________

Address_______________________________________________________

City / State / Zip____________________________________________

Phone number office____________________________________________

Home phone number__________________________________________________

Email_____________________________________________

There are different options for registration so please read carefully.

Payment Terms and Arrangements

Full Course Tuition (level 1 –4) is $4,400

Option 1 -If prepaid in full $3,800.00 ( payment must be sixty days before
course starts)
If you wish to prepay initial here_____

Option 2 -monthly payments -with a $1,400 deposit and $650.00
autodebited on the first of each month after classes
start for the next 4 months
Initial here for the autodebit option________

- Partial Tuition-
- Level 1 - $1,100.00

Single Level - Prepaid Tuition Plan

If you wish to register for only the first level initial here_______

 

If you have received information about classes and wish to attend, call The Institute at 1-800-752-2232 or Email mail@naturaldentistry.org

I plan to bring____staff members. I understand I will bring a check or be autodebited on the day of the seminar for a cost of $150.00 per staff member per day

Credit Card Information

Name (as it appears on the Card) _______________________________________

Billing Address ____________________________________________________

City/ State/ Zip/ ___________________________________________________

Card Number___________________________Expiration Date__________

Signature_________________________________________________________

Cancellation Policy - All cancellations need a thirty day notification. A $350.00 processing fee will be charged for all cancellations less then thirty days

Refund-Refunds are subject to a $250.00 fee plus any cancellation fees applicable.

I understand and agree to the terms, conditions and stipulations of this contract.

Signature__________________________________Date___________

General Information

•Please fill out and return the registration form along with the indicated tuition.
• Full payment must be received for registration to be valid. A letter of confirmation will be mailed to you once tuition payment has been received.
• Make checks payable to Institute for Nutritional Dentistry (IND).
• Credit Card registrations can be made by telephone or fax. MasterCard, Visa are accepted.
• Credit Card registrations may also be submitted via the internet. You may register through our secure website at naturaldentistry.org.
• Applications are processed in the order in which they are received. Last minute registrations will be accepted only if space is available. Please contact the Dean of Admissions before your arrival to ensure a space in the course.
• The Institute for Nutritional Dentistry (IND) is designated as an approved sponsor by the New Jersey Academy of General Dentistry.
• Refunds for courses will be granted for all cancellations received at least 30 days prior to the course date. Cancellations must be received in writing or faxed to the Dean of Admissions at 1-845-657-6612.
• Cancellations received less than 30 days prior to the course date will be charged a $350 incursion fee to cover hotel guarantees.
• A $100 registration fee is retained by the school when a refund is issued.
• A full refund will be granted if the school must cancel a course due to unforeseen circumstances. Attempts to contact all registrants will be made at the time cancellation is determined.
• IND is not responsible for reimbursement of a non-refundable airline ticket or other travel arrangements if a course is cancelled.
• Replacement verifications of participation for courses are $25.
• All disputes of an adversarial nature will be resolved by binding arbitration in a state designated by the IND.
• Fellowship Program: a four level, one year course at full tuition.
• Mentor Program: a two year course at reduced tuition preparing one for Mastery Level. May attend Mastery electives.
• Mastery Level: Faculty Status with election to designated departments with reduced tuition for Mastery electives.
• Courses are generally held at hotels located at or near international airports.
• Tape recorders are only permitted at the discretion of the instructor. Please notify us in advance if you wish to record a class so that approval may be obtained.
• IND courses are only available to registered participants. Last minute registrations will be honored if space permits. Staff may attend if properly registered.
• Institute for Nutritional Dentistry is committed to presenting the most current knowledge in dentistry. Some new theories and procedures may be deemed controversial.
• There is NO corporate Sponsorship of the Institute or its classes. The Institute believes this would undermine intellectual integrity. All fees are therefore changed to and collected from its student dentists.
• Please feel free to contact us if you have any questions about our programs or if you would like to register for our program.

• Telephone:

Philip Memoli DMD (NJ)
1-866-Natdent
Victor Zeines DDS (NY)
1-845-657-2322
Michael Margolis DDS (AZ)
1-602-363-9584
John Roberts B.CH.D. (UK)
1-484-51-4451

• Address: The Institute for Nutritional Dentistry

Executive Office: (CE Credits)
438 Springfield Avenue
Berkeley Heights, NJ 07922
Attn: P. Memoli DMD

Administrative Office: (Applications)
355 Chestnut Hill Road
Woodstock, NY 12498
Attn: V. Zeines DDS
Website: nutritionaldentistry.org


Please note: all disputes between the IND and any of its students will be resolved by binding arbitration