Please accept my application to become a member of the Dental Implant Mastermind. I believe that my application should be approved based on the following qualifications: (please select all that apply) *

I am willing to openly share my biggest challenges, ambitions, and goals so the group can offer insights & support

I’m commited to taking fast action to implement the knowledge gained from the Mastermind to grow my practice

I am willing to help others with my own advice & experience

First Name *

Last Name *

Name of Practice *

Practice Website *

Cell Phone Number *

Email *

How many implants do you place in an average week? *

Years In Practice *

How soon are you planning on pursuing Implant Dentistry in your practice? *

What are the top solutions you hope to find and implement as a member of the Dental Implant Mastermind? *

I understand that if I am qualified after a review of my application, a member of the member success team will contact me within 24-48 hours to provide me with the membership committee’s decision on my approval.

If I am approved for membership, I agree to pay the full annual membership fee in one payment of $10,500 or a payment plan of $997 per month.

Please type “I AGREE” in the box below.