2026 Continuing Education Credit Form
Friday-Saturday, August 7-8, 2026, Provo, Utah

Please note: In order to process your CE credit and send a certificate of attendance, you must complete this form with a valid e-mail address.

Your Certificate of Attendance will be emailed shortly after submission from ensigncademyofdentistry@gmail.com. Please add this e-mail address to your safe list so you can be sure to receive your certificate.  

If you provide a valid AGD Membership Number and submit by September 1, 2026, your credits will be reported directly to AGD. (Attendees are responsible for verifying AGD receipt).
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Full name as you want it to appear on your certificate
Email address
AGD membership number
License number
Complete mailing address
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