The ADA NSW Convention - Institute for Dental Implants
The ADA NSW Convention - Institute for Dental Implants
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