Retake Only Enrollment Form Step 1 of 3 33% Now enrolling for our next course starting Forum 10 April 27, 2020. If you cannot attend this course, subsequent courses will start Forum 11 September 1, 2020 and Forum 12 January 1, 2021.Name* First Last Email* Enter Email Confirm Email PLEASE MAKE SURE THIS IS EMAIL IS THE ONE YOU WANT TO RECEIVE ALL COMMUNICATIONS AND INVITATIONS FOR ACCESS THE COURSE MATERIALSName (as it appears on Facebook)YOU NEED A PERSONAL FACEBOOK ACCOUNT TO PARTICIPATE IN THIS GROUP PLEASE. PRACTICE PAGES ARE NOT ELIGIBLE.Practice's Name*To verify eligibility, please provide you practice's name and address. For students and faculty, please provide your institution and institution's address. This course provides ADA CERP certified for 45 CE hours of credit.Practice's Phone Number*Practice's Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Invisalign Clinical ID*Your clinical ID is REQUIRED for enrollment in I-Pro case support, which allows for live treatment planning support during our course. If you do not have an Invisalign Clinical ID, please write NO_IDPractice's Tax ID #Optional, to appear on your receipt.Which Course would you like to sign up for?*Select a DateForum 10 April 27, 2020Forum 11 September 1, 2020Forum 12 January 1, 2021Alumni Course Retake with CE Credits* Price: $550.00 NON-DISCLOSURE AGREEMENT This Agreement is made and entered into as of the last date signed below (the “Effective Date”) by and between The Aligner Intensive Fellowship©, a Missouri Limited Liability Company (“Disclosing Party”) and {Name (First):1.3} {Name (Last):1.6} (“Recipient”). WHEREAS The Aligner Intensive Fellowship © and {Name (First):1.3} {Name (Last):1.6} (collectively referred to as the “Parties”) have an interest in participating in discussions wherein Disclosing Party might share information with the Recipient that the Disclosing Party considers to be proprietary and confidential. NOW, THEREFORE, the Parties agree as follows: Confidential Information. “Confidential Information” shall include all confidential information or confidential material that is disclosed to Recipient by Disclosing Party that has commercial value or other utility in the business of Disclosing Party. Confidential Information includes but is not limited to (1) copyrighted materials such as learning materials, videos, power point presentations, pictures, any and all financial, technical, commercial or other information, records, reports, analyses, financial statements, compilations, studies, forms, business or management methods, marketing data, fee schedules, information technology systems and programs, projections, forecasts and trade secrets; (2) client lists, contacts, personnel, and suppliers; (3) inventions, processes, methods, products, patent applications, and other proprietary rights; or (4) specifications, drawings, sketches, models, samples, tools, computer programs, technical information and other related information. All intellectual property, including any copyrighted materials owned by Disclosing Party will not be replicated, sold or distributed by Recipient. All “Confidential Information” shared by the Disclosing party will be for the personal use only of the Recipient. Confidentiality Period. When informed of the proprietary and confidential nature of Confidential Information that has been disclosed by the Disclosing Party, the Recipient shall, for a period of five (5) years from the date of disclosure, refrain from disclosing such Confidential Information to any third party without prior, written approval from the Disclosing Party and shall protect such Confidential Information from inadvertent disclosure to a third party. The Recipient of Confidential Information disclosed under this Agreement shall promptly notify the Disclosing Party of any disclosure of such Confidential Information in violation of this Agreement or of any subpoena or other legal process requiring production or disclosure of said Confidential Information. Confidentiality And Non-Use Obligations. All Confidential Information disclosed under this Agreement shall be and remain the property of the Disclosing Party and nothing contained in this Agreement shall be construed as granting or conferring any rights to such Confidential Information to Recipient. The Recipient shall honor any request from the Disclosing Party to promptly return or destroy all copies of Confidential Information disclosed under this Agreement and all notes related to such Confidential Information. The Parties agree that the Disclosing Party will suffer irreparable injury if its Confidential Information is made public, released to a third party, or otherwise disclosed in breach of this Agreement and that the Disclosing Party shall be entitled to obtain injunctive relief against a threatened breach or continuation of any such breach and, in the event of such breach, an award of actual and exemplary damages from any court of competent jurisdiction. No Partnership. Nothing in this Agreement shall be construed to constitute an agency, partnership, joint venture, or other similar relationship between the Parties. Entire Agreement. This Agreement contains the entire agreement between the Parties and in no way creates an obligation for either Party to disclose information to the other Party or to enter into any other agreement. Governing Law. This Agreement and its performance shall be governed by the laws of the state of Missouri, without regard to its conflict of laws provisions. The Parties consent and submit to the exclusive jurisdiction of St. Louis County, state of Missouri, in all questions and controversies arising out of this Agreement. Billing Cycle. All PayPal accounts are automatically charged to their PayPal account on file. Billing periods typically begin on the day of the month in which customers purchase their The Aligner Intensive Fellowship subscription. The Aligner Intensive Fellowship will not prorate any portion of unused subscription services. All subscription fees are nonrefundable. If the PayPal is declined, The Aligner Intensive Fellowship will attempt to charge the account on file for 30 days. Late Fee: All accounts more than 30 days past due may be assessed a late fee. No fewer than three attempts to contact the customer will be made before any late fee is assessed. Delinquent Accounts: All accounts 30 days past due may be disabled until balances are paid in full. When disabled, all access will be suspended and data will be unavailable. Deactivation: After an account is delinquent 60 days, it will be cancelled due to non-payment. Once cancelled, the customer will not be able to recover any files until the account is current. Application data will be stored for 90 days post cancellation. After that, application data will not be available. The account record and delinquent balance will be submitted to a third-party collection service. Fees. Late Fee: The Aligner Fellowship may assess a $15.00 late fee for accounts 30 days past due. Collections Fee: In the event an account is submitted to a third-party collections service, a $15.00 processing fee may be assessed to the existing account balance. This fee is in addition to any other fees previously assessed on the account. Interest: Any charges not paid when due are subject to interest at a rate equal to the lesser of: (i) one and one-half percent (1.5%) per month; or (ii) the maximum interest rate allowed by applicable law. Billing Disputes As a current or prior customer of The Aligner Intensive Fellowship, each customer agrees to provide The Aligner Intensive Fellowship 30 days to attempt settlement of any billing dispute before disputing with any third-party credit/debit card company or bank. The Aligner Intensive Fellowship must be the first option in billing disputes. Should The Aligner Intensive Fellowship receive a chargeback from a third-party credit/debit card company or PayPal on the customer’s behalf before The Aligner Intensive Fellowship has been given a chance to resolve the issue, The Aligner Intensive Fellowship has the right to collect on the rendered services and any fees associated with those disputes. Regardless of the outcome of the chargeback, The Aligner Intensive Fellowship retains the right to collect on any rendered services or fees that are due. Profit Champs will submit any disputed amounts to a collection agency. Once a chargeback has been received, The Aligner Intensive Fellowship will immediately suspend the account until the matter is resolved. Refunds Subscription and Service fees are nonrefundable. Under extenuating circumstances we can change your Forum start date by request. IN WITNESS WHEREOF: 05/30/2020 Signature Date MAZYAR MOSHIRI The Aligner Intensive Fellowship LLC © Representative Signature*Print Name*DateI agree that the signature will me my electronic representation of my signature for all purposes when I (or my agent) use them on documents, including legally binding contracts - just the same as pen-and-paper signature.* I agree Unique ID Payment Information Payments are securely processed using PayPal.Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name Billing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Total $0.00 CommentsThis field is for validation purposes and should be left unchanged.
