Dr. Bukk, I has completed my dental work, and got borned agin! Please register my new Bukk Fambly name.
I suffered before under the name of
Now, I wants to be called
City & state where I stay at
My email address
This form is for folks who have purchased Dr. Bukk teef and undergone the miracle of metaphysical metamorphosis known as "gittin borned agin". Your new Fambly name will be entered into the Bukk Fambly Bible, as long as a patient record already exists. No duplications of names allowed! Check here first, or we'll notify you by email if your choice has already done been taken. Hint: if you like someone else's name, change the spelling a bit.

If your teef were bought for you by another, and you know that we have no record of you, then send in your green card for proof of Fambly membership.

Why register? Because Dr. Bukk will pay $5 for any person you 'begat' (refer)! If you ain't registered a new name, then Dr. Bukk jus keeps the money! It ain't Amway, but pays off quicker than witnessing.