Buy or Build Live Event Webinar

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2 Enter Information

3 Payment

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Buy or Build Live Event Webinar
Dates*
Quantity*
Select Number of Registrants for Buy or Build Live Event Webinar
General Admission*
X $99.00
General*
General Admission
The maximum allotted seats (10) has been exceeded; please remove seats to continue.
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Total
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Event Registration
Dentist/Owner Required Information.
Dentist/Owner First Name*
Last Name*
Position*
Will you (the dentist / owner) be attending the event?*
- Yes, I will be attending the event.
- No, only my staff / associates will be attending.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Personal Email*
Cell Phone*
Do you own or work for an existing practice?*
Practice Name*
Practice Email
Practice Website*
Primarily used to verify your position at the practice.
Practice Phone
May we contact your employer for employee verification?*
List any food restrictions
Are you a current or former client of Dental Whale Support Services?*
- Yes
- No
Why are you attending this seminar?*
- I am moving my existing practice
- I am adding on to my existing practice
- I am wanting to do a startup
- I would like to own multiple locations
- I would like more new patients
- I feel my accounts receivables need to be cleaned up
- My marketing isn't as good as it should be
- I spend too much money on dental IT support
- I have problems getting my dental equipment fixed properly and affordably
- I want to try and lower my supply/lab/equipment costs
- I don't know what I want to do
Please check all of the following steps that you have already completed:*
- I have not started any steps yet
- I have pulled demographic studies for my area
- I have searched available properties
- I have signed an LOI for a property
- I have signed the property lease
- I have finalized my floor plan design
- I have had architectural documents completed
- I have selected my contractor
- Construction has started
- I have selected my IT company
- I have selected my marketing company
- I have selected my cabinet maker
Which service(s)?*
- Breakaway Consulting
- Dental Whale Practice Group
- Front Desk DDS
- Unlimitech Dental IT
- Dental Whale Savings Network (DWSN)
- Conversion Whale
- Dental Fix Rx
How did you find out about our seminars & events?*
Tell us how you found out about our seminars & events*
Referred By
Have you previously attended a Breakaway Seminar?
- Yes
- No
Which seminar?
- Advanced Startup Seminar
- Business Masters Seminar
- Seminar for Group Practice Ownership
- Office Manager Mastery Seminar
Month/Year Attended
Do any of the prospective attendees represent or affiliate themselves with any vendor, consulting company, Dental Management Services Organization, or any other similar type of organization?*
- Yes
- No
We are unable to process your registration at this time. Please contact us at [email protected] Thank you!
Additional Attendees
Attendees registering as "staff" must send proof of employment to [email protected] within 5 business days of purchase to complete and confirm registration.
(i.e. paystub, business card, website verification, letter of employment verification etc.)
Attendee 1
Subject to Verification and Approval
Position*
Name*
First Last
Personal Email*

Each attendee must use a unique email address.
Cell Phone*
Food Restrictions
Attendee 2
Subject to Verification and Approval
Position*
Name*
First Last
Personal Email*

Each attendee must use a unique email address.
Cell Phone*
Food Restrictions
Attendee 3
Subject to Verification and Approval
Position*
Name*
First Last
Personal Email*

Each attendee must use a unique email address.
Cell Phone*
Food Restrictions
Attendee 4
Subject to Verification and Approval
Position*
Name*
First Last
Personal Email*

Each attendee must use a unique email address.
Cell Phone*
Food Restrictions
Attendee 5
Subject to Verification and Approval
Position*
Name*
First Last
Personal Email*

Each attendee must use a unique email address.
Cell Phone*
Food Restrictions
Attendee 6
Subject to Verification and Approval
Position*
Name*
First Last
Personal Email*

Each attendee must use a unique email address.
Cell Phone*
Food Restrictions
Attendee 7
Subject to Verification and Approval
Position*
Name*
First Last
Personal Email*

Each attendee must use a unique email address.
Cell Phone*
Food Restrictions
Attendee 8
Subject to Verification and Approval
Position*
Name*
First Last
Personal Email*

Each attendee must use a unique email address.
Cell Phone*
Food Restrictions
Attendee 9
Subject to Verification and Approval
Position*
Name*
First Last
Personal Email*

Each attendee must use a unique email address.
Cell Phone*
Food Restrictions
Attendee 10
Subject to Verification and Approval
Position*
Name*
First Last
Personal Email*

Each attendee must use a unique email address.
Cell Phone*
Food Restrictions
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Event Registration

We are unable to process your registration at this time. Please contact us at [email protected] Thank you!

Additional Attendees

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Attendee 4

Attendee 5

Attendee 6

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