Register Now

Pre-register for 2023!

We appreciate your support in this charitable initiative and your commitment to the oral health of all Canadians.

First Name

Last Name

Email Address

Practice Name

Practice Code

Required Event Information:

Date of Give Back, Smile Back initiative

Number of Appointments

Required Team Information:

Please enter the number of t-shirts you will need of each size below. Every member of your team that is participating will receive a t-shirt. Please type zero if you don't require any of a particular size.

Number of Staff Participating

Number of small t-shirts:

Number of medium t-shirts

Number of large t-shirts

Number of extra-large t-shirts

Any other information?

Is there any other information you would like us to know?

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https://www.redonnezunsourire.ca/site/register