Clinicians at the 72nd Annual Winter Clinic - Toronto Academy of ...

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WINTER CLINIC REGISTRATION FORM Friday, November 13th, 2009 y , ODA, ODHA, ODAA, & RDT MEMBERSHIP MBERSHIP MUST BE PAID IN FULL PRIOR TO REGISTRATION TION FOR WINTER CLINIC OTHERWISE NON-MEMBER MBER FEES APPLY REGISTRATION CATEGORY (please check ck off category) FEE ($) A. ODA Member Dentist (before November 6, 2009 ) $299.00 x ___ =________ _ B. Non-ODA Member Dentist (before November 6,2009) $359.00 x ___ =________ C. ODA Member Dentist (after November 6, 2008) $349.00 x ___ = _______ D. Non-ODA Member Dentist (after November 6, 2009 ) $469.00 x ___ =________ _ E. Registered Dentist’s Spouse (not dentist, hygienist or assistant) $100.00 x ___ =________ _ F. Post Grad Students, 2009 Grads, Interns (must pre-register) $158.00 x ___ =________ _ G. ODHA Member er (before November 6, 2009) $125.00 x ___ =________ _ H. ODHA Non-Member (before November 6, 2009) 0 $185.00 x ___ =________ _ I. ODHA Member er (after November 6, 2009) $152.00 x ___ =________ _ J. ODHA Non-Member (after November 6, 2009) $213.00 x ___ =________ _ K. ODHA Student Member (must pre-register) $ 78.00 x ___ =________ _ L. Technologistss (RDT Member) $158.00 x ___ =________ _ M. Technologistss (non-RDT Member) $174.00 x ___ =________ _ N. ODAA Member er (before November 6, 2009) $104.00 x ___ =________ _ O. ODAA Non-Member (before November 6, 2009) 09) $142.00 x ___ =________ _ P. ODAA Member er (after November 6, 2009) $131.00 x ___ =________ _ R. ODAAA Non-Member (after November 6, 2009 $169.00 x ___ =________ _ S. 50 Year ODA Member Complimentary x ___ =___0___ _0___ T. Active Member Canadian Forces Dental Unit Complimentary x ___=___ 0___ ___Dentist ____ Hygienist _____ Assistant Your badge is your receipt. No other receipt will be issued. GST # 123000879 HANDS-ON ($50) x ___= _______ Dentists who register office staff of 4 or more online, ne, including ing themselves will SUB-TOTAL $___________ receive a 15% discount if registering everyone before October 16, 2009 DISCOUNT $ ___________ _ Register er Online at tw www.tordent.com ww. TOTAL $ ___________ _ Badges will be mailed to attendees who register on or before October 16, 2009. Your badge must be worn at all times. If lost, a replacement badge will be issued on-site ONLY, with valid Photo I.D., for a fee of $50.00. There will be no exceptions. PRIMARY REGISTRANT (please print clearly) Name ____________________________________________________________ _ Email* _______________________________ _ Category (indicate letter from list above) ________ *All Email addresses are used strictly for Academy purposes, and are NOT shared with any other organization. Dentist’s RCDS Unique Code #______________ ODA Component Society___________ Specialty______ Year of Graduation _____________________ _ LAST NAME FIRST NAME CATEGORY 1) ___________________________ _________________________ _ __________ 2) ______________________________ ____________________________ _ ___________ _ 3) ______________________________ ____________________________ _ ___________ _ Full 4) ______________________________ Business B__ Mailing Address ________________________________________________________ _ _ 5)______________________________ City/Town /____ Province/State ____________________________ Postal _ Code /Zip___________ _ Business Tel. Number _____________________ _ Fax Number ____________________ _ PAYMENT METHOD (please indicate) Cheque (payable to Toronto Academy of Dentistry) Visa Mastercard Credit Card # _________________________________ _ Expiry Date (mm/yy) __________ Signature ___________________________________ Grand Total $ _______________ 970 Lawrence Ave W Suite 207 Toronto, Ontario M6A 3B6 416- 967-5649 www.tordent.com LIMITED ATTENDANCE *** I WILL _______ATTEND _ATTEND _____AM session ____ PM session Mary Costello $50.00 FEE to hold your spot for each session Refundable e after attending session MAILING INSTRUCTIONS *** Mail registration forms along with cheque or credit card number to: Toronto Academy of Dentistry 207-970 Lawrence Ave W Toronto, ON M6A 3B6 Faxed forms Will only be accepted if paid by credit card Fax # 416-967-5081
WINTER CLINIC REGISTRATION FORM Friday, November 13th, 2009 REGISTRANT (please print clearly) Name ____________________________________________________________ Email______________________________ Category (indicate letter from registration form) ________ Please indicate the names of the programs you and the members of your team would like to attend, so that we may allocate seating to accommodate you. Please complete one form for each of your team members. This survey does not obligate you to attend this speaker session, nor does it guarantee seating. U of T Update 8:45–3:30 ________ Zlotnik 11:00-12:00 ________ Peters 1:30–3:30 ________ Trache 8:45-11:30 ________ Klaiman 1:30–3:30 ________ Collie 8:45-9:45 ________ Costello Intro 9:00–11:30 ________ Cravit 10:00 -11:00 ________ Costello Advanced 1:30–3:30 ________ O’Keefe, Ellen,Fefergrad 9:00-11:30 ________ Haik 9:00–11:30 ________ Green 1:30-3:30 ________ Fefergrad, Wilton,Lenkinski 1:30–3:30 ________ Goldstep 9:00-11:30 ________ Lam 9:00–11:30 ________ Solomon 1:30–3:30 ________ Pillersdorf 1:30–3:30 ________ Ciancio 8:45-11:30 ________ Mahood 8:45-11:30 ________ Ciancio 1:30 -3:30 ________ Mahood 1:30–3:30 ________ McManama 8:45-11:30 ________ Nicolucci, Birek, Pynn 8:45 -11:45 ________ McManama 1:30 – 3:30 ________ Pearson 9:00–11:30 ________ Marcus 8:45–9:45 ________
Page 2 and 3: Simply The Best Sensor. The only di
Page 4 and 5: WINTER CLINIC IMPORTANT INFORMATION
Page 6 and 7: Our Academy Vision The Toronto Acad
Page 10 and 11: Who We Are Officers of the Toronto
Page 12 and 13: Greetings From... GREETINGS FROM TH
Page 14: Winter Clinic Highlights... Registe
Page 20 and 21: INITIATIVE Invisalign ® Clear Esse
Page 22 and 23: Invisalign ® Clear Essentials I RE
Page 24 and 25: Clinicians at the 72nd Annual Winte
Page 26 and 27: Of Interest to: Dentists Dental Hyg
Page 44 and 45: 72ND FRIDAY, ANNUAL NOVEMBER WINTER
Page 46 and 47: 2009 Exhibitors* 3M ESPE 300 Tartan
Page 48 and 49: 2009 Exhibitors* Ocean Pacific 500
Page 50 and 51: Oral Health Month Le mois de la san
Page 52 and 53: MEDIATIONS REPORT Gilbert Chapnick,
Page 54 and 55: Past Presidents The Past Presidents
Page 56 and 57: The Honourary Life Members of the T
Page 58 and 59:
Directory ONTARIO ASSOCIATION OF DE
Page 60:
Recommend Oral-B ® SmartSeries Wit
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