Pie Register – Registration ACDLA RegistrationPlease fill your dental lab information in the form below to register.Lab Name *Lab Address *Street AddressCity--Please Select --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificState Zip / Postal CodeLab Contact First Name *Lab Contact Last Name *Lab Email *Lab Phone *Lab FaxProviding a high quality product to my dentists is important to me and I guarantee my work. I do not use low quality materials or foreign services and I would not lower quality in order to win business. *I agreeI do not agreeI am not sureDelivering great service is a differentiating factor for my business. I care about the Dentists I work for and their patients. Removing the obstacles to make doing business with us easy for our Dentists is important to me and I seek to add value to the services I offer. *I agreeI do not agreeI am not sureMaintaining a professional work environment is important to me. Being professional is important to our industry’s future and creates credibility, so I am concerned about doing it right. *I agreeI do not agreeI am not sureUtilizing tools, materials and technology that increase quality, productivity, and responsiveness is important to the future of my business. I seek information about trends and advances in technology so I can be a resource for my customers and implement appropriate technology to improve my business. *I agreeI do not agreeI am not sureHow long have you been in the lab industry, as a whole? *Less than 1 year1 year2 years3 years4 years5-10 years10-15 years15-20 years20-25 years25-30 yearsMore than 30 yearsHow long have you been self-employed? *Less than 1 year1 year2 years3 years4 years5-10 years10-15 years15-20 years20-25 years25-30 yearsMore than 30 yearsHow many technicians (including yourself) work for your lab? *Are you Crown & Bridge, Denture or Full Service? *Crown & BridgeDentureFull ServiceHow many doctors do you currently service as customers? *Would you consider your dentists to be economy-minded, high-end, or a mixture? *economy-mindedhigh-enda mixtureDo you offer non-precious as an economic alternative? *yesnoWhat percentage of your work is non-precious? *How much do you charge for non-precious? *Do you offer any all-ceramic products such as Zirconia, e.max, etc.? *yesnoHow much do you charge for ceramics? *How much do you charge for PFM? *Do you outsource any work out of the United States? *noyesDo you have any plans for doing so in the future? *noyesAre you interested in doing more high-end work or are you happy where you are? *Yes, I am interestedNo, I am not interestedCreate a Username *Create a Password *Confirm Password *Weak PasswordPassword not enteredStrength IndicatorCompany LogoA logo is not required, but highly recommendedCredit Card Name *Credit Card Type *VisaAmerican ExpressMasterCardDiscoverCredit Card Number *CVV *I agree to the Terms and Conditions and Privacy Policy *YesRe-Captcha
