2022-23 Orthodontist Guide Submission Form

Submit your listing by completing this form.

Which Advertising Package Would You Prefer?*
- Overall Title Sponsorship (includes top listing in the guide, 4 weekend planner ads, 3 FB/IG stories, and 1 Instagram Reel captured by our team) - $1,200
- Gold Package (includes listing in guide, 3 weekend planner ads, and 3 FB/IG stories) - $500
- Silver Package (includes listing in guide and 3 weekend planner ads) - $400
- Bronze Package (includes listing in guide) - $250
- Please contact me about additional options (display ads, sponsored content, FB Live videos, weekend planner ads, attendance at hosted events, etc).
Facility Name*
Website*
Facebook Page*
Tell us about your practice in 2-3 sentences.*
Name of orthodontist(s) working in your practice*
Location*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email Address*

Used only if we need to contact you. Address will not be published.
File
Max. file size: 300 MB.
Please upload an image of your office or the logo that you would like displayed with your listing. No PDFs please.