Register for Wasted Days

Please fill out our meeting registration form!

First Name
Last Name
Name Suffix
Address 1
Address 2
State/Province/Territory (Outside North America)
Zip/Postal Code
Phone (day)
Phone (cell)
E-mail address
State/Province/Territory Licensed in:
Doctor and team member names attending Wasted Days and Sleepless Nights Advanced course
Total # of persons attending the retreat:
In case of an emergency at the meeting, please contact this person:
What previous intro to dental sleep medicine courses have you attended?
How many sleep appliances have you done in the last 12 months? Requirements for this coure is at least 10 in the last 2 years.
Do you own/use any home sleep test units?Yes   No  
Are you currently using a dedicated EMR or software for your sleep practice?Yes   No  
Are you currently using a third party billing company or billing yourself through medical insurance for your patient treatment?
Are there any special accommodations you need to make your conference experience more comfortable? (i.e., hearing assistance, accessibility, diet considerations)
Where did you learn about this course?
Elite Code, if any
Total Registration Cost
Credit Card Type
Credit Card #
Card Code
The organization reserves the right to substitute lecturers or to cancel or reschedule sessions due to low enrollment or other unforeseen circumstances.

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Our Newest  Event:

Wasted Days and Sleepless Nights

 Newly Registered Speakers:

Rubin Cheek

Fred Weiner

J.A. Shapira


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"The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn."
   -- Alvin Toffler

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Phones and Pagers at Meetings

When asked to turn off your phones and pagers at a meeting, what action do you take?
I turn it off
I put it on vibrate
I leave it on ring
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