R. J. ShAnkLE LECTuRE Roy b. hARRELL SyMPoSiuM

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Time Registration and continental breakfast will begin at 8:30am. The program will be held from 9:00am – 12:15pm. Morning Registration Fee & Credit The registration fee is $139 for dentists and $99 for team members. UNC Continuing Dental Education designates this activity for 3 hours of CDE credit. Both programs will be held at the UNC School of Dentistry. The UNC School of Dentistry is located at the corner of Manning Drive and South Columbia Street. Register for both programs on April 5 and lunch is on us! Registration Made Easy Be sure to fill out all applicable information on the registration form. Please make additional copies for each individual registration. Upon completion, you may either: • Register by Mail Send the completed registration form with a check or money order made payable to the UNC School of Dentistry to: Attention: Registration Dental Continuing Education Campus Box 7450 Chapel Hill, NC 27599-7450 • Register On-line Direct your web-browser to www.dentistry.unc.edu/cde/courses Questions? Call: 919-537-3400 or E-mail us at CDE@dentistry.unc.edu Time Registration will begin at 12:45pm. The program will be held from 1:15pm – 4:30pm. Afternoon Registration Fee & Credit The registration fee is $139 for dentists and $99 for team members. UNC Continuing Dental Education designates this activity for 3 hours of CDE credit. Refund Policy Since considerable advance planning is necessary for this continuing education program, a tuition refund, less a $30 fee, will be issued for cancellation received by March 29, 2013. The cancellation fee is necessary to cover materials and facilities costs incurred for each participant, which are non–refundable to us. No refunds will be issued after March 29, 2013. UNC School of Dentistry is an ADA CERP Recognized Provider. This continuing education program is presented by the University of North Carolina at Chapel Hill School of Dentistry’s Department of Endodontics, and the Continuing Dental Education program. The UNC Continuing Dental Education program is an ADA CERP Recognized Provider. UNC CDE’s term of recognition is May 2012 through June 2015. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at www.ada.org/cerp.
❏ ❏ ❏ registration form Friday, April 5, 2013 26th Annual <strong>Roy</strong> B. Harrell Symposium: Primary Management of Cleft Lip/Palate: The Role of the General/Pediatric Dentist Dentists $139 Team Members $99 29th Annual R. J. Shankle Lecture: Complex Endodontics from a Different Viewpoint Dentists $139 Team Members $99 Course Code: 13-CE-006 Course Code: 13-EN-002 Attend Both Courses (Lunch is included with your paid registration to both courses.) Dentist $278 Team Member $198 Please make additional copies for each person registering. ❏ DDS/DMD ❏ RDH ❏ DA ❏ LT ❏ Other________________________ First Name________________________________Last Name____________________________Jr./Sr. Badge Name ____________________________CDE ID#__________________❏ Male ❏ Female Employer __________________________________________________________________________ Mailing Address _____________________________________________________________________ City ____________________________________________ State ________ Zip ___________________ County in NC _______________________________________________________________________ Daytime Phone (_____)_________________________ Fax (_____) ___________________________ E-mail _____________________________________________________________________________ Check # _______________________________________ Check Amount $ ______________________ Register On-line with a Credit Card at www.dentistry.unc.edu/cde/courses The registration deadline is Friday, March 29, 2013. Date Received (office use only) _________________________________________________________ ❏ I have special needs. Please contact me. The University of North Carolina at Chapel Hill is committed to equality of educational opportunity and does not discriminate against applicants, students, or employees based on race, color, national origin, religion, sex, age, veteran status, or disability. Dental education institutions have an obligation to disseminate new knowledge related to dental practice. In so doing, some presentations may include controversial materials or commercial references. Sponsorship of a continuing education course by the University of North Carolina does not necessarily imply endorsement of a particular philosophy, procedure, or product by this institution. By providing my information, I consent to receive communications via mail, email, fax, and phone from the University of North Carolina Continuing Dental Education office. The Continuing Dental Education office will not share your information with anyone.
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R. J. ShAnkLE LECTuRE Roy b. hARRELL SyMPoSiuM

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