Registration Process

Q-Implant Marathon Registration Form

Please fill in all fields and return signed Registration Form to Implantology Courses

First Name:

Last Name:

Date of birth:

Company

Shipping address:

City:

State:

Zip code:

Country:

Telephone:

Mobile No:

Email:

Name for your Certificate:

AGD #:

Specialty:



Location:

Date:

Level:



Scrub size:



Current Implant Experience



I learned about this course by:



By signing and submitting your registration, you agree to the Q-Implant marathon terms and conditions.

To reserve your spot, we must receive the following:

  • Completed and Signed Registration Form
  • Deposit of $1,000 USD in the form of Credit Card, Check or Wire Transfer

Required documents:

  • Copy of Passport
  • Copy of Dental License
  • Copy of Dental School Diploma
  • Copy of Curriculum Vitae (outline any implant experience)
  • Copy of recent results from Infectious Disease Testing (Hepatitis B, C and HIV )*
    *(Results can be from a lab such as Quest Diagnostic, LabCorp etc. or a letter from physician)
  • Recent picture

Payment and Cancellation Policy:

  • All cancellations must be made in writing, no later than 4 weeks prior to the original course date. Tution is non-refundable after the 4 week mark, but can be transferred to another course date. Postponing course less than 10 days before arrival may incur a hotel and clinic fee.
  • Deposit of $1,000 USD is NON REFUNDABLE but can be transferred for up to 1 year.
  • Payments are due no later than 4 weeks prior to course, or upon registration, whichever comes first
  • Course dates are subject to change with prior notice from the organizer.

In Case of Emergency

List any medical condition we should be aware of

Emergency contact name

Emergency contact phone

Emergency contact relation

Payment

I am paying:

Deposit Only

In the form of:

Credit Card
Check (payable to Implantology Courses Inc and mailed to 710 W Higgins Rd Ste 102, Park Ridge IL 60068)
Wire Transfer

Signature

(With my Signature I confirm, that I accept the Q-Implant Marathon General Terms & Conditions)

Date:

Implantology Courses | 710 W Higgins Rd Suite 102, Park Ridge, IL 60068 | Tel: 877-705-1002 | Fax: 630-705-1003 | [email protected]

While our online application is under maintenance, please click on the link below for a PDF version of the registration form. To reserve your spot, please complete the registration form and email it over to [email protected].

A deposit of $1,000USD is required upon registration and spot reservation. The remaining tuition balance is due no later than 4 weeks before the session begins.
Please inquire for the price of the tuition, and ask about some of our current specials and discounts! We offer referral, early-bird, full payment, and recent grad discounts. Alternatively, you may finance your tuition for up to 12 months interest free. 
  1. Level 1 (implant placement): To attend our Level 1 course, you must have a valid dental license and proof of graduation/diploma. General dentistry knowledge is required, and basic theoretical Implantology knowledge is recommended.
  2. Level 2 (sinus lifts) : To attend our Level 2 course, you must have placed a minimum of 50 implants, or completed our Level 1 course.
  3. Level 3: To attend our Level 3 course, you must have extensive practical implantology and oral surgery experience, with placement of 200 implants, or completion of our Level 2 course.

Registration is only valid once a $1,000 deposit has been received. The deposit may be paid by credit card, check, or wire transfer. Once your spot is reserved, you will receive a confirmation email with all further details.

The course must be paid off in full before the course start date by:
  1. Full payment (credit card, check, wire transfer)
  2. In-house payment plan
  3. Lending Club Financing (interest free and extended plans available)
The following documents will need to be submitted by email or fax to our course coordinator, a few weeks before the course begins:
  1. Passport (copy or clear photo)
  2. Valid Dental License or Registration  (copy or clear photo)
  3. Dental Diploma (copy or clear photo)
  4. Resume
  5. Infectious Disease Medical Results
Please find a full list of our terms and conditions on our registration form.
Initial course deposits are non-refundable but can be transferred to a further course date with no penalty.
Course cancellations must be made in writing and submitted by certified mail, no later than 8 weeks prior to course date.
Last minute cancellations or course date transfers may be subject to penalty fees.
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