Registration Form*

First Name:
Last Name:
Specialty:	Please Select Your Specialty Oral Surgeon Plastic Surgeon Orthodontist ENT Dentist Other Dental ... Other Non Dental ...
Address:
City:
State/Province:	Postal Code:
Country:
Telephone:
Fax:
Email:
Purchase Date:	Please specify the date, when you purchased your copy of DO CD-ROM
Place of Purchase:	Please specify the place, where you purchased your copy of DO CD-ROM
Please Select your ID and Password for accessing updates and enhancements**:
ID:	(must be 8-to-20 characters)
Password:	(must be 8-to-20 characters)
	Click to send your registration information.
*	This form is to register the purchase of the DO CD-ROM
**	You will need your ID and Password to access password protected areas for registered DO-CD Users
To the DO Club	For any additional information send e-mail to CDROM@globalmednet.com