Annual Dental Review - UNC School of Dentistry - University of ...
Annual Dental Review - UNC School of Dentistry - University of ...
Annual Dental Review - UNC School of Dentistry - University of ...
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Registration<br />
30th <strong>Annual</strong> <strong>Dental</strong> <strong>Review</strong> at Myrtle Beach, SC<br />
thursday-Saturday, June 27-29, 2013 • Registration Deadline: June 17, 2013<br />
**Please duplicate form for each additional registration**<br />
Course Code: 13-OP-002<br />
Registration Fee: Dentist $495 Registration Fee: Team Member $285<br />
Single Day Rate: Thursday $190 Single Day Rate: Thursday $100<br />
Friday $190 Friday $100<br />
Saturday $190 Saturday $100<br />
First Name Last Name Jr. /Sr.<br />
Badge Name CDE ID# (if known) Male Female<br />
Employer<br />
Mailing Address<br />
City State Zip<br />
County in NC<br />
Daytime Phone (______)<br />
Fax (______)<br />
Email Address<br />
Check # Check Amount $<br />
**Please make checks payable to the <strong>UNC</strong> <strong>School</strong> <strong>of</strong> <strong>Dentistry</strong>.<br />
Register on-line with a Credit Card only for the full 3 day conference at<br />
www.dentistry.unc.edu/cde/courses<br />
Date Received (<strong>of</strong>fice use only)<br />
I have special needs, please contact me.<br />
The <strong>University</strong> <strong>of</strong> North Carolina at Chapel Hill is committed to equality <strong>of</strong> educational opportunity and does not<br />
discriminate against applicants, students, or employees based on race, color, national origin, religion, sex, age,<br />
veteran status, or disability.<br />
<strong>Dental</strong> education institutions have an obligation to disseminate new knowledge related to dental practice. In so<br />
doing, some presentations may include controversial materials or commercial references. Sponsorship <strong>of</strong> a<br />
continuing education course by the <strong>University</strong> <strong>of</strong> North Carolina does not necessarily imply endorsement <strong>of</strong> a<br />
particular philosophy, procedure, or product by this institution.<br />
By providing my information, I consent to receive communications via mail, email, fax, and phone from the<br />
<strong>University</strong> <strong>of</strong> North Carolina Continuing <strong>Dental</strong> Education <strong>of</strong>fice. The Continuing <strong>Dental</strong> Education <strong>of</strong>fice will not<br />
share your information with anyone.