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The ADA NSW Convention - Institute for Dental Implants

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<strong>The</strong> <strong>ADA</strong> <strong>NSW</strong> <strong>Convention</strong><br />

A convention <strong>for</strong> the whole dental team<br />

Fostering Teamwork, Furthering Technology<br />

Sydney <strong>Convention</strong> and Exhibition Centre, Sydney 13-15 September 2012


AN INVITATION<br />

the Chair of the Local Organising Committee<br />

<strong>The</strong> members of the Local Organising Committee of<br />

the <strong>NSW</strong> branch of the Australian <strong>Dental</strong> Association<br />

enthusiastically invite you to the <strong>ADA</strong> <strong>NSW</strong> <strong>Convention</strong><br />

2012 to be held at the Darling Harbour <strong>Convention</strong><br />

Centre in Sydney. This iconic venue will com<strong>for</strong>tably<br />

accommodate <strong>Convention</strong> participants and at the same<br />

time place attendees on Sydney city’s beautiful doorstep.<br />

day dentistry. However, dentistry encompasses the<br />

entire team -and exciting and riveting lectures will be<br />

available to all members of the oral health care fraternity.<br />

Dentistry is a dynamic profession that requires constant<br />

updating by its members - do not fall behind. This is an<br />

ideal <strong>Convention</strong> to absorb and rejuvenate yourselves<br />

the dentists, and your entire team.<br />

Speakers as well as scientific lectures are strongly aligned<br />

with the theme of the <strong>Convention</strong>-“<strong>The</strong> <strong>Dental</strong> Team”.<br />

Renowned international speakers John Sorensen,<br />

Bernice Ko, Eric Lowenhaupt, and Fridus Van der Weijden<br />

provide the basis <strong>for</strong> what promises to be a spectacular<br />

line up. Included will also be an array of talented Australian<br />

and New Zealand speakers.<br />

An extensive trade exhibition will keep the team updated<br />

with the latest technology in dentistry. In addition, a themed<br />

gala dinner promises to be an event not to be missed!<br />

<strong>The</strong> aim of the <strong>Convention</strong> is to provide participants<br />

with a current and comprehensive outline of modern<br />

<strong>The</strong> <strong>Convention</strong> will provide an opportunity <strong>for</strong> colleagues<br />

to learn, interact and socialise with each other.<br />

Remember that Together Everyone Achieves More.<br />

Yours Sincerely<br />

Larry Uria<br />

Chair<br />

<strong>ADA</strong> <strong>NSW</strong> <strong>Convention</strong> 2012 Local Organising Committee<br />

<strong>The</strong> <strong>ADA</strong> <strong>NSW</strong> 2012 <strong>Convention</strong> Local Organising Committee (LOC)<br />

LOC Committee Chair: Dr Larry Uria<br />

Committee Members: Dr Michelle Heffernan, Dr Jemima Kalos, Ms Barbara Hayes and Ms Rochelle McPherson<br />

<strong>Convention</strong> Organiser<br />

<strong>ADA</strong> <strong>NSW</strong> Centre <strong>for</strong> Professional Development<br />

PO Box 132, St Leonards <strong>NSW</strong> 1590 • Phone: 1800 737 346 • Fax: 02 8436 9933 • Email: convention@adansw.com.au<br />

OUR SPONSORS<br />

Platinum Sponsor Investec <strong>Dental</strong> Finance<br />

Investec <strong>Dental</strong> Finance is a specialist bank that provides<br />

financial solutions specifically <strong>for</strong> dental professionals.<br />

We are proud to again be the Platinum Sponsor of the<br />

<strong>ADA</strong> <strong>NSW</strong> <strong>Convention</strong> 2012.<br />

We invite you to find out more about our innovative range<br />

of distinctive banking products and services, which<br />

include; equipment, fit-out & motor vehicle finance, cash<br />

management facilities, commercial property finance,<br />

goodwill and practice purchase loans, home loans and<br />

professional overdrafts. For more in<strong>for</strong>mation, please visit us<br />

on stand or go to www.investec.com.au/professionalfinance<br />

Gold Sponsor Guild Insurance<br />

Guild Insurance is the largest insurer of allied health<br />

professionals in Australia, providing professional indemnity,<br />

business, car and home insurance to more than 90,000<br />

clients. With customer service staff located in every<br />

state, Guild Insurance delivers personal service to clients<br />

across Australia. For further in<strong>for</strong>mation visit our website<br />

at www.guildinsurance.com.au<br />

Silver Sponsor Colgate Oral Care<br />

Colgate-Palmolive is a global leader in oral care technology,<br />

products and education. Colgate’s products include<br />

technologically advanced toothpastes, toothbrushes,<br />

mouthrinses and dental floss.<br />

Colgate Professional Oral Care provides professional<br />

anticavity, gingival health, sensitivity and tooth whitening<br />

products. Colgate’s Bright Smiles Bright Futures program<br />

provides oral health education to millions of children<br />

around the world each year.<br />

For more in<strong>for</strong>mation please visit our trade display or<br />

visit www.colgateprofessional.com.au<br />

Silver Sponsor Biohorizons<br />

BioHorizons is one of the fastest growing companies in<br />

the dental implant industry. Our comprehensive<br />

portfolio of dental implants and biologics products is<br />

evidence-based and scientifically-proven. BioHorizons<br />

has continued to provide clinician’s unique products<br />

supported by university based research. Our combination<br />

of advanced implant technologies, biologics has enabled<br />

BioHorizons to provide comprehensive solutions <strong>for</strong><br />

both patients and clinicians. For further in<strong>for</strong>mation visit<br />

www.biohorizons.com or call 1300 13 12 19.<br />

Platinum Sponsor Gold Sponsor Silver Sponsor Silver Sponsor


VENUE All convention sessions and social functions will be held at the<br />

Sydney <strong>Convention</strong> and Exhibition Centre<br />

Darling Drive, Darling Harbour, Sydney <strong>NSW</strong> Australia<br />

SOCIAL & SPECIAL FUNCTIONS<br />

THURSDAY SATURDAY<br />

Welcome Reception<br />

Thursday, 13 September 2012<br />

6:00pm – 8:00pm<br />

Sydney <strong>Convention</strong> and Exhibition Centre<br />

You won’t want to miss this opportunity to relax and enjoy the company of your fellow <strong>Convention</strong> delegates and<br />

presenters, colleagues and friends overlooking the lights of Darling Harbour.<br />

Cost: Full <strong>Convention</strong> Delegates – included in your registration fee<br />

Additional Ticket – $95 inc GST<br />

Saturday Breakfast Session<br />

Saturday, 15 September 2012<br />

7:30am – 8:45am<br />

Sydney <strong>Convention</strong> and Exhibition Centre<br />

A <strong>Convention</strong> first which promises to be one of the most talked about sessions. Join us <strong>for</strong> a rare opportunity to hear<br />

Australian photojournalist Nigel Brennan who was kidnapped and held to ransom in Somalia in 2008. Be inspired by<br />

his story of survival, resilience and hope.<br />

Cost: Full <strong>Convention</strong> Delegates - included in your registration fee<br />

Additional Ticket - $75 inc GST<br />

<strong>Convention</strong> Gala Dinner<br />

Saturday, 15 September 2012<br />

6:30pm <strong>for</strong> 7:00pm<br />

Sydney <strong>Convention</strong> and Exhibition Centre<br />

<strong>The</strong> Gala Dinner has always been a memorable event in itself, and this one will be no exception. <strong>The</strong> Parkside Ballroom<br />

will be trans<strong>for</strong>med into the glitz, glamour and romance of the 1920’s as we immerse ourselves into the decadence of<br />

“<strong>The</strong> Great Gatsby”. Be entertained, surprised, wined and dined at what is shaping up to be the dental industry’s social<br />

event of the year. Numbers are limited <strong>for</strong> this event, so be sure to indicate if you will be attending when you register.<br />

Cost: Full <strong>Convention</strong> Delegates – included in your registration fee<br />

Additional Ticket - $225 inc GST<br />

SATURDAY<br />

INFORMATION<br />

Accommodation<br />

Special <strong>Convention</strong> rates have<br />

been secured at nearby Darling<br />

Harbour and Sydney Hotels.<br />

Book online at:<br />

http://conferences.ozaccom.com.<br />

au/2012/adn12/index.aspx<br />

Cancellation & refund policy<br />

By registering <strong>for</strong> this event, you<br />

agree to the cancellation and refund<br />

policy as outlined below:<br />

Cancellations must be notified in<br />

writing to the <strong>Convention</strong> Organiser.<br />

• Be<strong>for</strong>e 1 July 2012 will incur a<br />

$150 cancellation fee<br />

• Be<strong>for</strong>e 31 August 2012 will receive<br />

a 50% refund fee<br />

• After 31 August 2012 there will be<br />

no refund.<br />

Dietary requests<br />

All meal breaks will cater <strong>for</strong><br />

vegetarians, with gluten and dairy<br />

free options available.<br />

Should you have any additional<br />

dietary requests, please note these<br />

on the registration <strong>for</strong>m or contact<br />

the <strong>Convention</strong> Manager by email<br />

convention@adansw.com.au prior to<br />

1 September 2012. In some cases, an<br />

additional cost may apply.


SCIENTIFIC PROGRAM<br />

Friday, 14 September 2012<br />

Time Presentation Speaker<br />

9:10am – 9:50am <strong>Convention</strong> Opening Presentation Special Guest Speaker<br />

Air Chief Marshall Angus Houston<br />

9:50am – 10:50am Special Presentation Invited International Speaker<br />

Dr John Sorensen (USA)<br />

11:30am – 12:30pm<br />

Concurrent Sessions<br />

2:00pm – 3:15pm<br />

Concurrent Sessions<br />

3:45pm – 5:00pm<br />

Concurrent Sessions<br />

A Multidisciplinary Approach to Endodontics: Part 1<br />

Prevention and Treatment of Peri-implantitis: A Clinical Challenge<br />

Oral Appliance <strong>The</strong>rapy <strong>for</strong> Obstructive Sleep Apnoea<br />

E-Health Update<br />

<strong>Dental</strong> Team Session: Animal Dentistry<br />

Implant Maintenance<br />

Down In <strong>The</strong> Mouth: Oral Anatomy And Pathology Review<br />

Paediatric Dentistry<br />

Stem Cells: Building a new tooth: do we have the technology?<br />

Benchmark Your Practice<br />

Practice Management Session: Conflict Management<br />

Debilitated Dentitions – Are Composite Resin Restorations<br />

A Viable Option?<br />

Oral Hygiene Considerations For the Orthodontic Patient<br />

Genomics, transcriptomics and periodontal risk assessment<br />

<strong>Dental</strong> Team Session: A Day in the Paediatric <strong>Dental</strong> Practice<br />

Invited International Speaker<br />

Dr Bernice Ko (USA)<br />

Dr Lisa Heitz-Mayfield<br />

Dr Peter Cistulli & Dr Neil Peppitt<br />

Dr Neil Hewson<br />

Dr David Clarke<br />

Dr Fridus Van Der Weidjen<br />

Prof Jules Kieser and<br />

Assoc Prof Hedley Coleman<br />

Assoc Prof Richard Widmer<br />

Prof Mark Bartold<br />

Dr Brad Wright<br />

Mr Gary Smith<br />

Prof Ian Meyers<br />

Invited International Speaker<br />

Dr Eric Lowenhaupt (USA)<br />

Prof Greg Seymour<br />

Assoc Prof Richard Widmer


Time Presentation Speaker<br />

Saturday, 15 September 2012<br />

7:30am – 8:45am<br />

Saturday Breakfast Session<br />

Between the Horn of Africa and Hell<br />

Special Guest Speaker<br />

Mr Nigel Brennan<br />

9:00am – 10:00am A Multidisciplinary Approach to Endodontics: Part 2 Invited International Speaker<br />

Dr Bernice Ko (USA)<br />

9:00am - 10:30am<br />

Concurrent Sessions<br />

Explaining Professional Mystiques - is it necessary to write<br />

a novel?<br />

Microbiology<br />

Special Guest Speaker<br />

Stuart Littlemore QC<br />

Invited International Speaker<br />

Dr Fridus Van Der Weidjen<br />

(Netherlands)<br />

6 Possible Ways of Treating Class II Malocclusion with Invisalign Dr Morris Rapaport<br />

10:00am - 10:30am<br />

Concurrent Sessions<br />

11:10am – 12:30pm<br />

Concurrent Sessions<br />

2:00pm – 3:15pm<br />

Concurrent Sessions<br />

3:45pm - 5:00pm<br />

Concurrent Sessions<br />

Rehabilitation in Composite Resin, Limitations and Possibilities<br />

<strong>Dental</strong> Team Session: Oral Pathology<br />

Sealing Caries in Paediatric Patients<br />

Special Presentation from “Mr Money”<br />

Advanced Interpretation of Dentoalveolar Lesions<br />

Should we blame the techo - enhancing dentist ceramist<br />

communications<br />

Caries Prevention Cradle to Grave<br />

Pain Management<br />

Tots, tweens and teens. Paediatric dental trauma in<br />

everyday practice<br />

<strong>The</strong> Prevention and Treatment of <strong>Dental</strong> Trauma<br />

Special Presentation<br />

Management of the common congenitally missing teeth<br />

Managing hypomineralised / hypoplastic first permanent<br />

molars<br />

Cone Beam, Multislice CT, MRI, Intraoral and Panoramic<br />

Radiography<br />

<strong>Dental</strong> Team Session: Infection Control<br />

Is it Failure of Treatment or simply a Healing Variable<br />

Orthodontics<br />

Reminiscences’ of an “Incident” First Responder<br />

Gingival recession in our Orthodontic patients<br />

Practice Accreditation and My Practice – what’s in it <strong>for</strong> me?<br />

Dr Tony Rotondo<br />

Assoc Prof Hedley Coleman<br />

Assoc Prof Bernadette Drummond<br />

Special Guest Speaker<br />

Mr Paul Clitheroe AM<br />

Assoc Prof Bernard Koong<br />

Dr Chris Ho & Mr Brad Grobler<br />

Prof Laurence Walsh<br />

Prof Chris Peck<br />

Dr Juliette Scott<br />

Dr Brett Dorney<br />

Invited International Speaker<br />

Dr John Sorensen (USA)<br />

Dr Stephen Duncan<br />

Assoc Prof Bernadette Drummond<br />

Assoc Prof Bernard Koong<br />

Prof Laurence Walsh<br />

Dr Brian Fitzpatrick<br />

Prof Mehmet A. Darendeliler<br />

Dr Chris Griffiths<br />

Dr David Grossberg<br />

Dr Murray Thomas<br />

PLUS…<br />

Concurrent Sessions<br />

• Hands-on Clinical Workshops with special guest international and local presenters<br />

• Live Clinical Demonstrations<br />

• Workshops on Medical Emergencies, Practice Management Software,<br />

Computerised Dentistry and much more<br />

• Industry Exhibition


OUR PRESENTERS<br />

Dr John Sorensen<br />

Dr John Sorensen DMD, PhD is an internationally recognised expert in prosthodontics, ceramic<br />

restorations, crown & bridge systems and implant abutment systems. Dr Sorensen has taught<br />

dentists both in the United States and internationally. Currently working at the Pacific <strong>Dental</strong><br />

<strong>Institute</strong> Education Centre in Oregon, Dr Sorensen teaches dentists in hands on courses how<br />

to per<strong>for</strong>m aesthetic, implant and reconstructive dentistry procedures. He is on the editorial<br />

boards of numerous professional dental publications and has published more than 75 scientific<br />

articles and over 100 dental research abstracts. Dr John Sorensen is sponsored by 3M ESPE.<br />

Dr Bernice Ko<br />

Dr Bernice Ko is the Course Director of the University of Cali<strong>for</strong>nia, Los Angeles (UCLA)<br />

Endodontic Continuum Lecture and Hands-on Workshop, serving local and <strong>for</strong>eign general.<br />

Dr Ko is a Diplomate with the American Board of Endodontics and is a Lecturer with the<br />

Section of Endodontics at UCLA. She maintains an Endodontic-Periodontic private practice<br />

in West Los Angeles, Cali<strong>for</strong>nia. Dr Bernice Ko is sponsored by Sybron Endo.<br />

Professor Lisa Heitz-Mayfield<br />

Professor Heitz–Mayfield, an Adelaide graduate, obtained a Masters in Periodontology (1996)<br />

and PhD (1998) from Lund University, Sweden. She received a scholarship at the Brånemark<br />

Osseointegration Centre, Sweden, and an ITI scholarship at the University of Berne, Switzerland<br />

where she became Head of the Oral Microbiology Research Laboratory, 1999-2003.<br />

Her positions include Professor at the CRROH, UWA, <strong>The</strong> University of Sydney, and <strong>The</strong> University<br />

of Hong Kong and maintains a specialist practice in Perth.<br />

Dr Fridus Van Der Weidjen<br />

Dr Fridus van der Weijden graduated in 1984 from the State University <strong>Dental</strong> School in<br />

Utrecht, the Netherlands and was accredited by the Dutch Society of Periodontology<br />

in 1990. He received accreditation as a ‘senior investigator’ by the Netherlands <strong>Institute</strong> <strong>for</strong><br />

<strong>Dental</strong> Sciences in 2000, and in 2005 as an ‘Implant-specialist’ by the Dutch Society of Oral<br />

Implantology. Dr Fridus van der Weijden is sponsored by Oral B.<br />

Prof Jules Kieser<br />

Jules Kieser obtained a BSc from the University of the Witwatersrand, South Africa, in 1971<br />

be<strong>for</strong>e going on to qualify as a dentist in 1975. He went into practice first in the outback of<br />

South Africa and subsequently in London and Johannesburg. While in practice, he received his<br />

PhD in 1989 and was appointed as Reader in Craniofacial Biology and also Honorary Professor<br />

of Anatomy at Wits. In 1996 he was appointed to the Chair, and Head of the Department of<br />

Oral Sciences, University of Otago in Dunedin, New Zealand.<br />

Assoc Prof Richard Widmer<br />

A/Prof Richard Widmer is the Head of Department at the Children’s Hospital at Westmead,<br />

and is also in private specialist practice. Richard has a broad experience in clinical paediatric<br />

dentistry as well as being a very active teacher of under-graduates and post graduates across<br />

all health disciplines. Richard is also the co-editor of “<strong>The</strong> Handbook of Paediatric Dentistry “,<br />

now in its third edition and available in seven languages.<br />

Assoc Prof Hedley Coleman<br />

Assoc Professor Coleman graduated with distinction as a dentist in 1985 from the University<br />

of the Witwatersrand in Johannesburg, South Africa. He completed a Masters Degree in the<br />

Branch of Oral Pathology in 1992. In 2003 he obtained a Fellowship from the South African<br />

College of Pathologists and in 2007 fulfilled the examination requirements <strong>for</strong> the Fellowship<br />

in the Faculty of Oral and Maxillofacial Pathology (Royal College of Pathologists of Australasia).<br />

He presently holds a conjoint appointment as Associate Professor with the ICPMR, Westmead<br />

Hospital and the Faculty of Dentistry, University of Sydney.


Prof Mark Bartold<br />

Professor Bartold is currently Professor and Director of the Colgate Australian Clinical <strong>Dental</strong><br />

Research Centre at the University of Adelaide. He is a member of the editorial board of<br />

eight international dental journals and is the current Editor of the Australian <strong>Dental</strong> Journal.<br />

Professor Bartold has authored over 200 scientific articles in the field of periodontology.<br />

In addition to his research and teaching commitments he also maintains a private specialist<br />

periodontics practice.<br />

Prof Ian Meyers<br />

Professor Meyers is currently in general dental practice in Brisbane, and has honorary<br />

professorial positions with <strong>The</strong> University of Queensland School of Dentistry, and James Cook<br />

University School of Medicine and Dentistry. His major interests include adhesive restorative<br />

dental materials, diagnosis and management of the worn dentition and minimum<br />

intervention dentistry.<br />

Dr Eric B. Lowenhaupt<br />

Dr Lowenhaupt, D.D.S. attended Florida State University <strong>for</strong> undergraduate studies and Emory<br />

University in Atlanta <strong>for</strong> his <strong>Dental</strong> and Orthodontic training. Since 1986, he has been in the<br />

private practice of Orthodontics and Dentofacial Orthopedics in Florida. Eric lectures nationally<br />

and internationally through his affiliation with (G) nathos (<strong>The</strong> Ricketts School <strong>for</strong> Bioprogressive<br />

Education, Southeast) and VOCA (Vital Orthodontic Considerations Australasia).<br />

Prof Greg Seymour<br />

Professor Seymour is a clinical periodontist and is Dean of the Faculty of Dentistry and<br />

Professor of Periodontology at the University of Otago, New Zealand. He is also co-director<br />

of the Molecular Immunopathology Group in the Sir John Walsh Research <strong>Institute</strong> at the<br />

University of Otago. He has authored or co-authored over 330 papers in the scientific literature<br />

in the areas of periodontology and oral immunology and has been awarded a number of<br />

international research prizes.<br />

Stuart Littlemore QC<br />

Stuart Littlemore is a barrister, author, documentarian and creator of ABC TV’s ‘Media Watch’.<br />

Stuart is one of Her Majesty’s Counsel, practising at the Bar in Sydney, Melbourne, Canberra,<br />

Brisbane, Hobart, Perth, Papua New Guinea and Vanuatu. In his legal work, he specialises in<br />

media law, criminal law and administrative law.<br />

Assoc Prof Bernadette Drummond<br />

Professor Drummond is currently head of the Discipline of Paediatric Dentistry at the University<br />

of Otago where she co-ordinates two graduate programmes, and provides specialist clinical<br />

care <strong>for</strong> children and adolescents. Her research focuses on improving the oral health-related<br />

quality of life in children, particularly those with teeth anomalies, severe early childhood<br />

caries or medical and developmental disabilities. She has investigated the long-term success<br />

of restoring children’s teeth and a range of novel preventive approaches.<br />

Assoc Prof Bernard Koong<br />

Bernard consults full time and is a partner at a multidisciplinary comprehensive private<br />

radiology group in Western Australia and also consults internationally. He also holds the<br />

position of Associate Professor at the University of Hong Kong, where he provides radiology<br />

programmes <strong>for</strong> Faculty of Dentistry journal. He presents internationally and is published<br />

extensively in journals and textbooks.<br />

Prof Laurence Walsh<br />

Professor Walsh is well known to Australian and international audiences. Laurie has authored<br />

over 200 research publications, over 40 national or state level protocols and guidelines, and<br />

over 150 technical reports and literature reviews. His research publications have attracted<br />

over 3200 citations. Laurie has been the Head of the University of Queensland School of<br />

Dentistry since 2004. He maintains a part-time specialist practice in special needs dentistry,<br />

and serves on the <strong>ADA</strong> Inc Infection Control Committee.


Don’t like filling out <strong>for</strong>ms? Register online at www.adansw.com.au/convention<br />

REGISTRATION FORM<br />

DELEGATE DETAILS<br />

Title: First Name: Surname<br />

Organisation/Practice:<br />

Postal address: Suburb/Town: State: Postcode:<br />

Phone: Fax: Mobile:<br />

Email<br />

Special Dietary Requests:<br />

REGISTRATION FEES<br />

Full <strong>Convention</strong> Registration Fee INC GST<br />

Includes access to convention sessions, morning and afternoon tea, lunch, welcome reception, gala dinner, satchel, industry exhibition entry and Saturday breakfast session<br />

Category<br />

Early Bird Rate<br />

(by 31 July 2012)<br />

Standard Registration<br />

(from 1 August 2012)<br />

Dentist – <strong>ADA</strong> Member Membership No.: $1350 $1650<br />

Dentist – Non Member $1450 $1750<br />

Dentist Assistant – <strong>NSW</strong> DAA Member <strong>NSW</strong> DAA Membership No.: $495 $495<br />

<strong>Dental</strong> Assistant – Non <strong>NSW</strong> DAA Member $495 $550<br />

<strong>Dental</strong> Auxiliary employed by <strong>ADA</strong> Member Employer’s <strong>ADA</strong> Membership No.: $1000 $1000<br />

<strong>Dental</strong> Auxiliary not employed by <strong>ADA</strong> Member $1350 $1650<br />

Corporate/Technician/Prosthetist $1750 $1750<br />

Complimentary Functions INC GST<br />

Pleases indicate if you will be attending these functions (1 x tickets is included in the Full <strong>Convention</strong> Registration fee, however RSVP is required <strong>for</strong> catering purposes).<br />

Date Function Yes, I will be attending No, I will not be attending<br />

Thursday, 13 September 2012<br />

Saturday, 15 September 2012<br />

Saturday, 15 September 2012<br />

Welcome Reception: 6:00pm – 8:00pm<br />

Breakfast Session: 7:30am – 8:45am<br />

<strong>Convention</strong> Gala Dinner: 6:30pm <strong>for</strong> 7:00pm Dinner<br />

One Day Registration INC GST<br />

Includes access to convention sessions, morning and afternoon tea, lunch and industry exhibition <strong>for</strong> one day only. Does not include access to welcome reception, gala<br />

dinner or Saturday breakfast session. Tickets <strong>for</strong> these events can be purchased separately in the Additional Functions section.<br />

Category Fri, 14 Sept 2012 Sat, 15 Sept 2012<br />

Dentist – <strong>ADA</strong> Member Membership No.: $750 $750<br />

Dentist – Non Member $875 $875<br />

Dentist Assistant – <strong>NSW</strong> DAA Member <strong>NSW</strong> DAA Membership No.: $250 $250<br />

<strong>Dental</strong> Assistant – Non <strong>NSW</strong> DAA Member $275 $275<br />

<strong>Dental</strong> Auxiliary employed by <strong>ADA</strong> Member Employer’s <strong>ADA</strong> Membership No.: $500 $500<br />

<strong>Dental</strong> Auxiliary not employed by <strong>ADA</strong> Member $825 $825<br />

Corporate/Technician/Prosthetist $875 $875<br />

Additional Functions INC GST<br />

One (1) ticket <strong>for</strong> each of these functions is included in the Full <strong>Convention</strong> Registration Fee. Additional tickets may be purchased <strong>for</strong> guests/partners, or One Day registration.<br />

Date Function Cost (inc GST) Name/s of attendee<br />

Thursday, 13 September 2012 Welcome Reception: 6:00pm – 8:00pm _______ x tickets at $95<br />

Saturday, 15 September 2012 Breakfast Session: 7:30am – 8:45am _______ x tickets at $75<br />

Saturday, 15 September 2012 <strong>Convention</strong> Gala Dinner: 6:30pm <strong>for</strong> 7:00pm Dinner _______ x tickets at $225<br />

TOTAL $<br />

PAYMENT DETAILS<br />

A cheque payable to <strong>ADA</strong> <strong>NSW</strong> Centre <strong>for</strong> Professional Development<br />

Please charge the total amount to the following credit card: Visa Mastercard American Express<br />

Card Number Security Code (on back of card/front on AMEX) Expiry Date<br />

Cardholder Name<br />

Cardholder Signature

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