ASSISTING REGISTRATION FORM My AIO Email * First Name * Last Name * Street Address * City * State * Choose... AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Zip Code * Cell Phone * Work Phone * Home Phone Email * Doctor's Name * Doctor's Phone* Practice Type * Doctor's Email * Enter the letters/numbers from the box above* Click on the SUBMIT REGISTRATION button above to submit and pay for your registration. Your registration will not be processed unless payment has been received. Once you complete the payment process, you will see a confirmation message. Registration Cost Class Name Class Dates Location Instructor(s) Cancellation Policy: Refunds only available if entire course is cancelled. Please make checks payable to:IAO New EnglandDr. David Levine, DDS888 Western AvenueAlbany, NY 12203518-435-1104 We also accept PayPal, search for IAONEWENGLAND.