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Remodel, Relearn, Relax - Entry Form

Personal

First Name *

Last Name *

Email Address *

Address 1 *

Address 2

City *

State *

ZIP *

Business

Office Phone # *

Fax #

Other Degree

Practice Name

Primary Field of Practice

Your Occupation

Do you place Implants?

Choose your degree

I am planning to purchase the following products within the next 12 months

CAD-CAM

Caries Detection Device

Core Buildup

Curing Light

Dental Chairs-Furniture

Dental Washer Disinfector

Digital Impression System

Extraoral Imaging System

Hand Instrument Cassette

Hand Mirrors

Handpieces Electric

Handpieces Air

Headlight

Implants

Intraoral Cameras

Intraoral Imaging Sensors & Software

Laser

Lead Free Aprons

Lighting

Loupes

Magnification

Practice Management Software

Scalers (Power)

Sensor Holders

Single Tooth Anesthesia System

Within the next 12 months I am planning to change some of the products I am currently using

Anchors

Anesthesia

Articulating Paper

Bonding Agents

Burs

Cements

Composites

Core Buildup

Curettes-Scalers

Eyewear

Floss

Gingival Retraction Material

Gloves

Implants

Impression Materials

Impression Trays

Interproximal Brushes

Masks

Matrix Band

Prophy Angles

Prophy Paste

Rinses

Scrubs

Sealants

Shade Matching

Toothbrushes

Varnish

Whitening

Wipes

Operatory

Do you plan to add an operatory or refurbish a current operatory within the next 12 months?

Subscription Details

In what city were your born

I would like to receive a subscription to Dental Product Shopper magazine (USA Residents Only)

Newsletters

I would like to receive Dental Product Shopper eNews and First Look newsletters.

Yes

I would like to receive CE invitations and/or special promotional offers from Dental Product Shopper marketing partners.

Yes

I would be interested in participating in FREE 1 hour educational on-line seminars (Webinars).

Yes

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Remodel, Relearn, Relax Official Rules

Home > Remodel, Relearn, Relax - Entry Form

Prize Details

Remodel • Relearn • Relax
The Choice is Yours

Grand Prize

REMODEL

Estimated Value: $290,000
Everything you need to get started with an office remodel.
Click Here for a list of items included.

RELEARN

$10,000 for tuition reimbursement
$5,000 in travel certificates
Click Here for more details.

RELAX

$10,000 for travel anywhere in the world
$5,000 in cash for spending
Click Here for more details.

Second Place

$2,000 cash prize

Third Place

$1,000 cash prize

Click Here for official rules and prize details