OICDE Online CE Registration Form

Please fill out the form below and Dr. Arcoria will CALL YOU BACK to confirm the registration and to receive your credit card information.  DO NOT ATTACH ANY CREDIT CARD INFORMATION TO THIS E-MAIL.

Be specific regarding the course name(s):

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* 1. Be specific regarding the course name(s):

Contact Information:

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* 2. Contact Information:

Place any registration comments that you have below and Dr. Arcoria will discuss these with you:

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* 3. Place any registration comments that you have below and Dr. Arcoria will discuss these with you:

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