Complete Your Registration

To register and become an official ASAP member, please fill out the short form below. When you select "Submit This Form", you will be taken to our secured vendor to input your billing information and complete the registration process.

If you select to receive your copy of The Million-Dollar Prosthodontist as an e-book, your digital receipt will include download instructions. If you select the hard copy, it will be mailed to the office address you provide in the form below. You will also receive an e-mail receipt.

Note: The information you provide will be used to create your official listing in our Prosthodontist Locator. Be sure to print all information as you would like it to appear in your listing.

Amount $275.00      
Additional Donation      
Credit Card Type   Address
Book Type   City
Desired Username   State
password   Zip
Re-enter Password   Phone
Office Name   Email
First Name   Website
Last Name   Image
Max file size = 4MB. Image size should be 150w X 150h
Second location information (optional)
Address   City
State   Zip