2012 FALL - The American Academy of Dental Sleep Medicine

aadsm.org

2012 FALL - The American Academy of Dental Sleep Medicine

A A D S M E d u c a t i o n a l C o u r s e s

Fall 2012

October 27-28, 2012 | mgm grand | las vegas,nevada

Register online at www.aadsm.org

ADVANCED DENTAL

SLEEP MEDICINE

INTRODUCTION TO

DENTAL SLEEP MEDICINE

new companion course!

PRACTICE MANAGEMENT


Advanced Dental Sleep Medicine

Course Chair: Michael Simmons, DMD | Vice-Chair: David Schwartz, DDS

October 27-28, 2012

Target Audience

This course is intended for dentists with seasoned experience providing oral appliance

therapy for patients with sleep disordered breathing who have an interest in

incorporating better management of complex treatment, expectations and outcomes.

Course Overview

This course will build on the clinical skills and depth of understanding attendees have

gained from treating sleep related breathing disorders. Topics will widen attendee’s

perspective and enhance your skill set for those patients who fall outside the routine.

Lectures from a world class faculty group will address issues surrounding the “sleeping

brain” including relationships to brain damage, development of cognitive problems,

bruxism and preventive or therapeutic strategies for such issues. Clinical protocols will be

addressed via combination therapies utilizing telegnathic and soft tissue approaches to

enhance treatment outcomes. There will be presentations and panel discussions under

the heading of the “T’s of Sleep” addressing Terminology, Testing, Treatment, Titration, and

Termination of oral appliance therapy.

Course Objectives

Upon completion of the course, participants will be able to:

• Discuss brain related issues surrounding sleep disordered breathing, preventive

measures and the potential impact of oral appliance therapy with patients and other

health care providers;

• Identify patients who may benefit from surgical and combination approaches in the

management of their sleep disordered breathing; and

• Recognize and implement strategies for long-term collaborative management of sleep

disordered breathing patients.

TEACHING METHODS

The sessions at this course will comprise lectures followed by discussion.

CONTINUING EDUCATION

The American Academy of Dental Sleep Medicine is an ADA CERP Recognized Provider.

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. The American Academy of Dental Sleep Medicine designates this

activity for 13.00 continuing education credits.

2 Register online at www.aadsm.org


mgmgrand las vegas,nevada

SESSION TIMES

Saturday, October 27

7:00 AM – 7:45 AM* Continental Breakfast and Registration

7:45 AM – 12:15 PM General Session

12:15 PM – 1:15 PM* Lunch

1:15 PM – 6:00 PM General Session

Sunday, October 28

7:15 AM – 8:00 AM* Continental Breakfast

8:00 AM – 12:30 PM General Session

*These meals are provided; attendees are responsible for all other meals.

This course includes an exhibit hall that will be open during breaks and lunch.

LIST OF TOPICS AND FACULTY

Brain Damage, Sleep Disorders & Oral Appliance Therapy: An Overview

Michael Simmons, DMD

Neurophysiology of Sleep and its Relation to Breathing

Jerald Simmons, MD

The Sleeping Brain: Normal and Pathological Conditions

Ron Harper, PhD

CNS Morbidity in Pediatric Sleep Apnea

David Gozal, MD

Brain Damage, Central and Complex Sleep Apnea: Relevance in Clinical Practice

Daniel Norman, MD

Brain Injury Accompanying Sleep Disordered Breathing: Extent, Prevention and Recovery

Ron Harper, PhD

The Sleep/Bruxism Connection & Treatments in Managing Obstructive

Respirations During Sleep

Jerald Simmons, MD

Treatment Considerations in Pediatric Sleep Disordered Breathing

David Gozal, MD

Bruxism and SDB: Connections or Coincidences

TBD

The T’s of Sleep Terminology & Treatment Overview

Michael Simmons, DMD

Otolaryngological Airway Issues and Collaborative Treatment Approaches to

Sleep Disordered Breathing

Ryan Soose, MD

Contemporary Maxillofacial Treatment In Collaborative Sdb Care

Robert Relle, DDS

Testing, Titration and Termination of OAT

David Schwartz, DDS; Todd Morgan, DMD; and Daniel Norman, MD

Questions? Call the AADSM @ (630) 737-9761 3


introduction to Dental Sleep Medicine

Course Chair: R. Bruce Templeton, DMD | Vice-Chair: Kevin Postol, DDS

October 27-28, 2012

TARGET AUDIENCE

This course is intended for dentists and dental professionals with an interest in, or currently

treating, snoring and obstructive sleep apnea (OSA) patients through the utilization of oral

appliance therapy (OAT).

COURSE OVERVIEW

The Introduction to Dental Sleep Medicine course is a logical way to incorporate OAT into

your practice. The course includes a review of sleep related breathing disorders, such as

snoring and OSA, and the impact of sleep disorders on society. A comprehensive evaluation

is described that includes upper airway examination and imaging with a focus on areas of

pathophysiology in OSA. Several sessions address the range of OAT and upper airway surgery

for OSA. The course addresses practice issues such as developing a team approach, medicolegal

issues and reimbursement. A final portion of the course is case-based and provides

clinical examples of the evaluation and treatment of sleep disorders in a dental practice.

Course Objectives

Upon completion of the course, participants will be able to:

• Describe the dental and medical terminology associated with sleep medicine and OSA;

• Understand the pathophysiology, demographics and sequelae of OSA;

• Evaluate, analyze and comprehend polysomnogram reports and understand the

necessity of medical evaluation and importance of a multidisciplinary team approach

to treating snoring and OSA;

• Identify and describe the various treatment options available, focusing on the various

types of oral appliances available;

• Describe the mechanisms of action of various types of oral appliances as well as the

indications, contraindications, complications and side effects associated with their use;

• Evaluate various case presentations that demonstrate a range of patients and

treatment situations representative of the practice of dental sleep medicine to

include fabrication concepts, interpretation of bite registrations and adherence to

recommended treatment protocol and standards of practice; and

• Apply practical concepts for building and developing a successful dental sleep medicine

practice, including an overview of informed consent, relationships with physicians,

sources of patient referrals, follow-up with current patients, record keeping, and medical

insurance billing.

TEACHING METHODS

The sessions at this course will comprise lectures followed by discussion.

CONTINUING EDUCATION

The American Academy of Dental Sleep Medicine is an ADA CERP Recognized Provider.

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. The American Academy of Dental Sleep Medicine designates this activity

for 12.00 continuing education credits.

4


mgmgrand las vegas,nevada

SESSION TIMES

Saturday, October 27

7:00 AM – 7:45 AM* Continental Breakfast and Registration

7:45 AM – 12:15 PM General Session

12:15 PM – 1:15 PM* Lunch

1:15 PM – 5:30 PM General Session

Sunday, October 28

7:15 AM – 8:00 AM* Continental Breakfast

8:00 AM – 12:30 PM General Session

*These meals are provided; attendees are responsible for all other meals.

This course includes an exhibit hall that will be open during breaks and lunch.

LIST OF TOPICS AND FACULTY

OSA: Pathophysiology, Health Risks and Diagnosis with Polysomnography

Kelly Carden, MD, MBA

OSA: Medical Management with CPAP and Behavioral Therapies

Kelly Carden, MD, MBA

Diagnostic Testing, Including Airway Imaging, Home Monitors, and Oral Examination

R. Bruce Templeton, DMD

OAT: Types and Mechanisms of Action

B. Gail Demko, DMD

OAT: Titration of Mandibular Advancement Devices with Home Sleep Tests

and in-lab PSG protocols

Sheri Katz, DDS and B. Gail Demko, DMD

Various Methods of Taking Impressions and Records

Kevin Postol, DDS and faculty

OAT: Insertion, Adjustments, Side Effects and Complications

B. Gail Demko, DMD

Surgery for OSA

Jeffrey Prinsell, DMD, MD

Practice Marketing and Patient Management: A Team Approach

Robert Rogers, DMD

Scope of Practice, Medico-legal Issues and ABDSM Board Certification

Robert Rogers, DMD and Jeffrey Prinsell, DMD, MD

Insurance Reimbursement

B. Gail Demko, DMD

Case Presentations

Kevin Postol, DDS

Questions? Call the AADSM @ (630) 737-9761 5


practice management

Course Chair: Lydia Sosenko, DDS | October 28, 2012

This half-day course is an add-on to the Advanced Dental Sleep

Medicine and the Introduction to Dental Sleep Medicine courses;

individuals must be registered for either the Advanced Dental Sleep

Medicine course or the Introduction to Dental Sleep Medicine course

in order to participate in this course.

TARGET AUDIENCE

This course is intended for auxiliary, office staff, and dentists and dental professionals with

an interest in, or currently treating, snoring and obstructive sleep apnea (OSA) patients

through the utilization of oral appliance therapy (OAT).

COURSE OVERVIEW

This course will provide office staff and dentists with a basic understanding of billing issues,

customer service and referrals.

Course Objectives

Upon completion of the course, participants will be able to:

• Understand a variety of paths to introduce dental sleep medicine to your practice;

• Apply practical systems to effectively deliver oral appliance therapy;

• Implement successful billing techniques; and

• Utilize several different platforms to gain a dental sleep patient base including

physician referrals, as well as internal and external marketing programs.

TEACHING METHODS

The sessions at this course will comprise lectures followed by discussion.

CONTINUING EDUCATION

The American Academy of Dental Sleep Medicine is an ADA CERP Recognized Provider.

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. The American Academy of Dental Sleep Medicine designates this

activity for 4.00 continuing education credits.

6 Register online at www.aadsm.org


mgmgrand las vegas,nevada

SESSION TIMES

Sunday, October 28

12:30 PM – 1:30 PM* Lunch

1:30 PM – 5:45 PM General Session

*This meal is provided; attendees are responsible for all other meals.

This course includes an exhibit hall that will be open during breaks and lunch.

LIST OF TOPICS AND FACULTY

Options for Implementing Dental Sleep Medicine

Lydia Sosenko, DDS

Establishing a Dental Sleep Medicine Patient Base

Lydia Sosenko, DDS

Strengthening Your Systems for Oral Appliance Therapy

Lydia Sosenko, DDS

Successful Billing for Dental Sleep Medicine

Jan Palmer

Amenities

30,000 sq.ft Grand Spa & Salon

5 Pools and Lazy River

Exclusive Retail Shops

Las Vegas Monorail Station

Photos © www.mgmresortsimages.com

Questions? Call the AADSM @ (630) 737-9761 7


speaker index

AADSM Fall Courses | October 27 - 28, 2012

Kelly Carden, MD, MBA

Dr. Carden obtained her

MD and MBA degrees at

the University of Tennessee

and continued her training

in internal medicine at

Baylor College of Medicine in Houston.

She then obtained her Pulmonary/Critical

Care and Sleep Medicine fellowship

training at Harvard Medical School. She

is actively involved in the AASM and the

AADSM, serves as a lecturer at a number of

courses and sits on multiple committees.

She is currently employed with St. Thomas

Physician Services in Nashville, Tennessee

and is affiliated The Center for Sleep which

is an AASM-accredited laboratory.

B. Gail Demko, DMD

Dr. Demko received her

DMD from Boston University

and was a hospital-based

dentist at Beth Israel

Deaconess Medical Center

in Boston for 20 years. In 1997 she limited

her dental practice to the treatment of OSA

and is an expert advisor to the FDA on oral

appliance therapy. She is the 2012 -2014

President of the AADSM and is a recipient

of the AADSM Distinguished Service Award.

David Gozal, MD

Dr. Gozal is currently

the Herbert T. Abelson

Professor and Chairman

of the Department of

Pediatrics at the University

of Chicago and Physician in Chief of the

Comer Children’s Hospital in Chicago. Dr

Gozal’s research interests emphasize bench

to bedside approaches to pediatric sleep

disorders, with projects encompassing

a wide range of interests, such as gene

and cellular regulation in hypoxia, murine

models of sleep disorders, and genomic

and proteomic approaches to clinical and

8 Register online at www.aadsm.org

epidemiological aspects of sleep in children,

including collaborative work in several

countries around the world.

ron harper, phd

Dr. Harper received his

doctorate from McMaster

University (Ontario,

Canada), and is currently

a Distinguished Professor

in the Department of Neurobiology, David

Geffen School of Medicine at UCLA, and

a member of the UCLA Brain Research

Institute. His research program examines

neural mechanisms underlying control of

breathing and cardiovascular action during

sleep, principally through physiological

and brain imaging studies of humans with

normal and disordered breathing in sleep.

Sheri Katz, DDS

Dr. Katz received her DDS

from Emory University and

practices within a family

practice in Decatur, Georgia.

Her primary interest and

focus of practice is dental sleep medicine.

She has served on the AASM Standards of

Practice Task Force for OSA Surgery and was

the 2010-2012 President of the AADSM.

todd morgaN, DMD

Dr. Morgan is a clinician

and researcher with 20

years experience in dental

sleep medicine. His team

has completed several NIH

funded clinical trials and authored several

peer-reviewed articles and books on the

treatment of sleep apnea with dental

appliances. His work in screening for OSA

among dental patients and its relationship

to TMJ dysfunction will help the practitioner

better understand who to select for oral

appliance therapy. He is a Diplomate of the

American Board of Dental Sleep Medicine

and sits on the AADSM Board of Directors.


Daniel Norman, MD

Dr. Norman graduated

summa cum laude from

UCLA with a bachelor

of science degree in

Neuroscience. He then

attended UC Irvine College of Medicine,

where his academic excellence was

recognized by his election to Alpha Omega

Alpha and the National Dean’s List.

Dr. Norman is board certified in Sleep

Medicine, Internal Medicine, Pulmonary

Disease, and Critical Care Medicine.

jan palmer

Ms. Palmer has been

involved in the field of

dentistry since 1982. In

1999 sbegan to learn about

the medical insurance

industry and how to maximize insurance

benefits for dental sleep medicine. She has

since formed her own consulting business

for training dental offices on how to properly

understand the medical insurance world

for treatment of obstructive sleep apnea

with oral appliance therapy to maximize the

patient’s benefits.

Kevin Postol, DDS

Dr. Postol received his

dental degree from the

University of Missouri-

Kansas City and attended

the University of Iowa for

a GPR. He entered the field of dental

sleep medicine in 2007 and later became

a Diplomate of the American Board of

Dental Sleep Medicine in 2011. Dr. Postol

maintains a general dental practice in St.

Louis, MO and a dental sleep medicine

practice simultaneously.

Jeffrey Prinsell, DMD, MD

Dr. Prinsell received his

DMD from Tufts University

and his MD from Vanderbilt

University. He completed a

GPR in Dentistry, a General

Surgery Internship and an OMS Residency

at Vanderbilt. He is a surgical consultant

at several metro-Atlanta sleep centers

and maintains an OMS private practice in

Marietta, Georgia. He is a Diplomate of the

ABOMS, has served on the AASM Standards

of Practice Task Force for OSA Surgery, is

Chair of the AAOMS CIG on OSA Surgery, is

Founding President of the ABDSM and a Past

President of the AADSM.

robert relle, dds

Dr. Relle is a Diplomate

of the American Board

of Oral and Maxillofacial

Surgery. Dr. Relle attended

Indiana University School

of Dentistry prior to completing his surgical

training at Harbor/UCLA Medical Center in

Los Angeles. His office is located in Century

City, California, and the focus of his practice

is orthognathic and reconstructive surgery,

and surgical management of obstructive

sleep apnea. He has a part-time faculty

appointment at the UCLA School of Dentistry

and is completing his term as an examiner

for the ABOMS.

Robert Rogers, DMD

Dr. Rogers received his

DMD from the University

of Pittsburgh. He was

Director of Dental Medicine

for St. Barnabas Medical

Center in Gibsonia, PA and is Director of

Clinical Services for Pittsburgh Dental Sleep

Medicine. He has a special interest in the

treatment of OSA and works with many

Pittsburgh area sleep centers. He served

on the AASM Standards of Practice Task

Force for OAT. He is the Founding President

of the AADSM and is a recipient of the

AADSM Distinguished Service Award.

david schwartz, dds

Dr. Schwartz has been

a practicing general

restorative dentist since

1988, and he has expertise

in all fields of dentistry with

a concentration in dental sleep medicine for

the last 12 years. He has educated dentists

Questions? Call the AADSM @ (630) 737-9761 9


around the world on the benefits of dental

sleep medicine and has lectured at various

study clubs and dental organizations. Dr.

Schwartz is a Diplomate of the American

Board of Dental Sleep Medicine. He is

currently director of Dental Sleep Medicine

at The Center for Sleep Medicine in the

Chicago-land area locations.

jerald simmons, md

Dr. Simmons is the

Founding Director of

Comprehensive Sleep

Medicine Associates,

the Sadler Clinic Sleep

Disorders Center and the Sleep

Education Consortium, all located in

the greater Houston area. Dr. Simmons

conducts clinical research related to

Neurology, sleep and dentistry. With years

of experience working with dentists he

is currently researching the relationship

between Sleep Bruxism and obstructive

respirations during sleep.

michael simmons, DMD

Dr. Simmons maintains two

private practices focusing

on TMJ/orofacial pain and

sleep-disordered breathing

as well as providing

general dentistry. He is a Diplomate of

the American Board of Orofacial Pain,

Fellow in Pain Management UCLA School

of Medicine, Fellow American Academy

of Orofacial Pain and a Fellow of the

Academy of General Dentistry. He serves

on the Boards of the AADSM, ASAA and

his local dental society. Dr. Simmons

is a frequent lecturer across the U.S.,

having published original research in

peer reviewed journals, authored book

chapters and completed a children’s book

on drowsy driving.

ryan j. soose, md

Dr. Soose is the Director

of the UPMC Division of

Sleep Surgery and Assistant

Professor of Otolaryngology

at the University of Pittsburgh

School of Medicine. Board Certified in both

otolaryngology and sleep medicine, Dr.

Soose specializes in the medical and surgical

treatment of snoring and obstructive sleep

apnea. Dr. Soose has a special interest

in drug-induced sleep endoscopy in the

evaluation and management of patients with

sleep apnea.

lydia sosenko, dds

Dr. Sosenko received

her dental degree from

the University of Illinois

in Chicago. She entered

the world of dental sleep

medicine in 1998. She is a Diplomate of the

American Board of Dental Sleep Medicine

and has limited her practice to dental sleep

medicine while maintaining a general dental

practice. This business arrangement allows

her the unique position of seeing daily

obstacles in a general dental practice as

well as specific obstacles in the practice

management of dental sleep medicine.

R. Bruce Templeton, DMD

Dr. Templeton received his

DMD from the University

of Manitoba, Canada

and completed an OMS

Residency at the University

of Minnesota. He is a Diplomate of

the ABOMS, past Chief of Surgery at

Northern Memorial Medical Center,

past Chief of Dentistry at MN Children’s

Medical Center, Chief of OMS at the VA

Hospital in Minnesota, Clinical Professor

at the University of Minnesota Faculty of

Dentistry, Vice President of the Minnesota

Dental Association and President of

the Minnesota Society of OMS. He has

served on the AADSM Board of Directors.

10 Register online at www.aadsm.org


general information

AADSM Fall Courses | October 27 - 28, 2012

ROOM RESERVATIONS

Hotel: MGM Grand | 3799 Las Vegas Boulevard South, Las Vegas, Nevada 89109

Rate: $169.00 per night plus tax. Rate includes daily resort fee (complimentary

in-room internet access, daily newspaper, complimentary printing of boarding pass,

unlimited local and toll-free calls and complimentary access to the Cardio Room).

Rate Available Until: Friday, September 28, 2012 or until the room block sells out

Reservations: To make reservations online, visit www.aadsm.org/FallWinterCourse.aspx.

To make reservations by phone, call 1-800-929-1111 and reference the AADSM group

rate.

Check In Time: 3:00pm

Check Out Time: 11:00am

For more information please visit the hotel website at www.mgmgrand.com.

TRANSPORTATION

Attendees may contact Corporate Travel to purchase airline tickets. Call toll-free (800)

526-4540 on Monday-Friday from 8:00am-5:00pm Central. We suggest you make your

travel arrangements as soon as you receive your registration confirmation.

The airport nearest to MGM Grand is the Las Vegas McCarran International Airport.

The hotel is approximately 3 miles from the airport.

MEALS

Breakfast and lunch will be served on Saturday, and breakfast will be served on

Sunday. Lunch will be served on Sunday for attendees of the Practice Management

course; all other meals are the responsibility of the attendees. Only registered

attendees are allowed to attend meal functions. Guests of attendees will not be

accommodated during meal functions.

CONFIRMATION

Confirmations will be sent via email within one week of receipt of registration form and

payment. All participants must pre-register for courses; on-site registration will not be

accepted.

The AADSM will not be held liable if an individual purchases an airline ticket before

receiving confirmation of registration for this course.

CANCELLATION & REFUND POLICY

To cancel a registration, written notification must be submitted to the AADSM. A

$50.00 administrative fee will be withheld on cancellations postmarked prior to Friday,

October 5, 2012. After this date, no refunds will be available. Refunds are not provided

to no-shows.The AADSM reserves the right to cancel the course and provide a

full refund should conditions warrant. The refund will only include the cost of registration

for the course.

Questions? Call the AADSM @ (630) 737-9761 11


RECORDING

Photographing and /or recording, of any kind, of sessions and speakers at the

courses are strictly prohibited.

DRESS CODE

Dress code at the courses is business casual.

INFORMATION OR QUESTIONS

For information or questions regarding the courses, please contact:

Randi Prince, AADSM Coordinator

Email: rprince@aadsm.org | Website: www.aadsm.org

dining & ENTERTAINMENT

171,000-sq.ft. casino

KÁ and Hollywood Theater

Race & Sports Book

Joel Robuchon at the Mansion

Emeril Lagasse’s New Orleans Fish House

Craftsteak

NOBHILL

Pearl

L’Atelier de Joel Robuchon

Rainforest Cafe

Starbucks

Grand Wok & Sushi Bar

Wolfgang Puck Bar & Grill

Photos © www.mgmresortsimages.com

12 Register online at www.aadsm.org


egISTRATION instructions

AADSM Fall Courses | October 27 - 28, 2012

how to register

Online (credit card only)

www.aadsm.org

Fax (credit card only)

(630) 737-9790

Mail (check or credit card)

American Academy of

Dental Sleep Medicine

2510 North Frontage Road

Darien, IL 60561-1511

Registration Disclaimer

Registration is limited. Please register early. Confirmation letters will be sent via email

within one week of receipt of registration form and payment. All attendees must

pre-register by Friday, October 19th; after this date registration will not be accepted.

The AADSM will not be held liable if an individual purchases an airline ticket before

receiving confirmation of registration for these courses.

Registration Categories

Member - To register as a member, the registrant must currently be an individual

member of the American Academy of Dental Sleep Medicine (AADSM). If the AADSM is

unable to confirm that the individual is a member of the society, the AADSM will register

the individual as a nonmember at the prevailing fee.

Student Member - To register as a student member, the registrant must currently be a

student member of the AADSM. If the AADSM is unable to confirm that the individual is

a student member of the society, the AADSM will register the student as a nonmember

at the prevailing fee.

Dental Staff of AADSM Member - To register as the dental staff of an AADSM member,

the registrant must currently be employed by an individual who is currently a member

of the AADSM. If the AADSM is unable to confirm that the dentist is a member of the

AADSM, the AADSM will register the individuals as a dental staff of a nonmember at the

prevailing fee.

Nonmember - Want to register for the member price, but you’re not a member? Join

the AADSM to receive instant savings including reduced course registration fees, a

listing on the Find-a-Dentist feature of the AADSM website, subscriptions to Sleep and

Breathing and Dialogue and much more. Visit the AADSM website at www.aadsm.

org for more information about membership including a complete list of benefits and

a description of all membership categories. Membership is on a calendar-year basis

(January 1–December 31). On June 1, 2012, the membership dues for Regular

Members are prorated. Membership dues for 2012 are:

Regular Members - $345

Student Members - Free with completion of the AADSM Student Membership Application.

Dental Staff of Nonmember - If your employer is not an individual member of

the AADSM and would like to become a member, please request that he or she

completes the membership application form available at www.aadsm.org. Visit the

AADSM website at www.aadsm.org for more information about membership including

a complete listing of benefits.

Questions? Call the AADSM @ (630) 737-9761 13


egistration fees

AADSM Fall Courses | October 27 - 28, 2012

On or before September 28, 2012

Advanced

Course Only

Introduction

Course Only

Advanced Course

+ Practice

Management

Course

Introduction

Course + Practice

Management

Course

AADSM Member $550 $550 $740 $740

AADSM Student

Member $425 $425 $570 $570

Dental Staff of

AADSM Member $425 $425 $570 $570

Dental Staff of

Nonmember $525 $525 $700 $700

Nonmember $650 $650 $870 $870

After September 28, 2012

Advanced

Course Only

Introduction

Course Only

Advanced Course

+ Practice

Management

Course

Introduction

Course + Practice

Management

Course

AADSM Member $650 $650 $870 $870

AADSM Student

Member $525 $525 $700 $700

Dental Staff of

AADSM Member $525 $525 $700 $700

Dental Staff of

Nonmember $625 $625 $835 $835

Nonmember $750 $750 $1,000 $1,000

Electronic Course Materials

In its continued effort to “Go Green,” the AADSM will provide course materials in an

electronic format only. Course attendees will be provided with the course materials

on a thumb drive at the course. Prior to the course, attendees will be allowed to

download and print the course materials if that is the format they prefer. Please

note that the AADSM will not supply computers or tablets to view the material,

power for computers or tablets or internet access. It is imperative that attendees

wishing to view the course materials on their laptops or tablets have them

sufficiently powered prior to arrival at the course each day.

14 Register online at www.aadsm.org


REGISTRATION FORM (please print clearly)

Full Name:

Address:

(This is the name that will be on your name badge)

Degree(s):

City: State: Zip/Postal Code:

Phone:

Fax:

Email:

Special Needs/Accommodations:

Attendee List Permission (Check one)

I give my permission to include my contact information on an attendee list to be distributed to

course attendees. Yes No

Exhibitor List Permission (Check one)

I give my permission to include my contact information on an attendee list to be distributed to

course exhibitors. Yes No

2012 Membership Dues for Nonmembers (Check one)

Regular Members $345 (Membership dues are prorated to $175 from June 1 to Sept 30, 2012)

Student Members Free with completion of AADSM Student Application.

COURSE REGISTRATION (check one)

Introduction to Dental Sleep Medicine Course only

Introduction to Dental Sleep Medicine Course and Practice Management Course

Advanced Dental Sleep Medicine Course only

Advanced Dental Sleep Medicine Course and Practice Management Course

Membership status

AADSM Member AADSM Student Member

Dental Staff of AADSM Member

Employer’s Member Number:

Employer’s Member Email:

Nonmember

Dental Staff of Nonmember

Employer’s Email:

registration fees

(Based on the course(s) that you will attend, date of payment and membership status, please fill

in the appropriate registration fee as found on page 14 of this brochure.)

$___________________

Method of Payment

Please make checks payable to the AADSM (U.S. funds drawn on a U.S. bank)

For payment by credit card (VISA/MasterCard/American Express):

Card#:

Exp. Date: / Validation Code * :

Cardholders Name:

(email required to receive confirmation)

Detach and Return

Mailing Address:

Signature: Date: /

*For a VISA or MasterCard, the validation code is the last 3 numbers in the signature box. For an American Express, the validation code is the 4

numbers above the credit card number.

Questions? Call the AADSM @ (630) 737-9761 15


AMERICAN ACADEMY OF DENTAL SLEEP MEDICINE

2510 North Frontage Road

Darien, Illinois 60561-1511

A A D S M E d u c a t i o n a l C o u r s e s

Fall 2012

October 27-28, 2012 | mgm grand | las vegas,nevada

Register online at www.aadsm.org

ADVANCED DENTAL

SLEEP MEDICINE

INTRODUCTION TO

DENTAL SLEEP MEDICINE

new companion course!

PRACTICE MANAGEMENT

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