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COURSES - The American Academy of Dental Sleep Medicine

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all 2011courses• Advanced <strong>Dental</strong><strong>Sleep</strong> <strong>Medicine</strong>• Introduction To <strong>Dental</strong><strong>Sleep</strong> <strong>Medicine</strong>November 12-13, 2011AADSM National Office • Darien, IllinoisRegister online at www.aadsm.org


Advanced <strong>Dental</strong> <strong>Sleep</strong> <strong>Medicine</strong>November 12-13, 2011 | AADSM National Office | Darien, IllinoisTARGET AUDIENCEThis course is intended for dentists with some experience providing oral appliancetherapy for patients with sleep related breathing disorders and have an interest inmanagement <strong>of</strong> treatment expectations.COURSE OVERVIEWThis course will build on the clinical skills you have gained from treating sleep relatedbreathing disorders and enhance your skill set for those patients who fall outside theroutine. Lectures will detail the upper airway anatomy and explore Cognitive Behavioral<strong>The</strong>rapy, a branch <strong>of</strong> psychotherapy devoted to the behavioral aspects <strong>of</strong> this field. Advicefor educating sleep technologists on device titration during follow-up studies will give youways to ensure your therapy is maximized. A sleep dentist who is working within a sleeplab will share the best practices, the positives and the negatives <strong>of</strong> the evolving nature<strong>of</strong> dental sleep medicine practice. Diplomates <strong>of</strong> the <strong>American</strong> Board <strong>of</strong> <strong>Dental</strong> <strong>Sleep</strong><strong>Medicine</strong> (ABDSM) will moderate group and panel discussions, and Diplomate casestudies will guide a dialogue on reliable treatment outcome predictors. Didactic lectureswill be supplemented with attendee discussions on common practice managementissues, OAT side-effects, and methods for treating complications.Course ObjectivesUpon completion <strong>of</strong> the course, participants will be able to:• Identify patients who demonstrate anatomical or behavioral reasons why initiatingtherapy might not be the best option;• Recognize predictors <strong>of</strong> treatment success so expectations <strong>of</strong> the dentist,physician, and patient can be properly managed;• Recognize and correct complications that occur with OAT;• Utilize a consistent method for titrating an oral appliance in the sleep lab;• Discuss the airway anatomy in detail; and• Understand better and be able to discuss with patients and physicians the role thatcognitive behavioral therapy can play in treating sleep related breathing disorders.TEACHING METHODS<strong>The</strong> sessions at this course will be comprised <strong>of</strong> lectures followed by discussion.CONTINUING EDUCATION<strong>The</strong> <strong>American</strong> <strong>Academy</strong> <strong>of</strong> <strong>Dental</strong> <strong>Sleep</strong> <strong>Medicine</strong> is an ADA CERP RecognizedProvider. ADA CERP is a service <strong>of</strong> the <strong>American</strong> <strong>Dental</strong> Association to assist dentalpr<strong>of</strong>essionals in identifying quality providers <strong>of</strong> continuing dental education. ADACERP does not approve or endorse individual courses or instructors, nor does it implyacceptance <strong>of</strong> credit hours by boards <strong>of</strong> dentistry. <strong>The</strong> <strong>American</strong> <strong>Academy</strong> <strong>of</strong> <strong>Dental</strong><strong>Sleep</strong> <strong>Medicine</strong> designates this activity for 13.00 continuing education credits.Register online at www.aadsm.org


SESSION TIMESSaturday, November 127:00 AM – 7:45 AM* Continental Breakfast and Registration7:45 AM – 12:00 PM General Session12:00 PM – 1:00 PM* Lunch1:00 PM – 5:30 PM General SessionSunday, November 137:15 AM – 8:00 AM* Continental Breakfast8:00 AM – 1:15 PM General Session*<strong>The</strong>se 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 FACULTYCognitive Behavioral <strong>The</strong>rapyCarla Hellekson, MDOral Appliance <strong>The</strong>rapy: Titration <strong>of</strong> Mandibular Advancement Devices with Home<strong>Sleep</strong> Tests and In-lab PSG ProtocolsJames Metz, DDSAnatomy <strong>of</strong> the Airway: <strong>The</strong> Good and the Bad <strong>of</strong> ItRichard Finn, DDSCompliance Monitors for OAT Case PresentationsSteve Carstensen, DDSPredictors <strong>of</strong> Success: Data from Real Life PracticeKathleen Bennett, DDS and Timothy Kitzmiller, DDSUpdate on Complications <strong>of</strong> Oral Appliance <strong>The</strong>rapySheri Katz, DDS, AADSM President<strong>The</strong> <strong>Dental</strong> <strong>Sleep</strong> <strong>Medicine</strong> Practice in the <strong>Sleep</strong> LabDavid Schwartz, DDSDiscussion on Complications and SolutionsSteve Carstensen, DDSQuestions? Call the AADSM at (630) 737-9705


INTRODUCTION TO DENTAL SLEEP MEDICINENovember 12-13, 2011 | AADSM National Office | Darien, IllinoisTARGET AUDIENCEThis course is intended for dentists and dental pr<strong>of</strong>essionals with an interest in, orcurrently treating, snoring and obstructive sleep apnea (OSA) patients through theutilization <strong>of</strong> oral appliance therapy (OAT).COURSE OVERVIEW<strong>The</strong> Introduction to <strong>Dental</strong> <strong>Sleep</strong> <strong>Medicine</strong> course is a logical way to incorporate OAT intoyour practice. <strong>The</strong> course includes a review <strong>of</strong> sleep related breathing disorders, such assnoring and OSA, and the impact <strong>of</strong> sleep disorders on society. A comprehensive evaluationis described that includes upper airway examination and imaging with a focus on areas <strong>of</strong>pathophysiology in OSA. <strong>The</strong> course also addresses practice issues such as developing ateam approach, medico-legal issues and reimbursement. A final portion <strong>of</strong> the course is casebasedand provides clinical examples <strong>of</strong> the evaluation and treatment <strong>of</strong> sleep disorders in adental practice.Course Objectives• Describe the dental and medical terminology associated with sleep medicine and OSA.• Understand the pathophysiology, demographics and sequelae <strong>of</strong> OSA.• Evaluate, analyze and comprehend polysomnogram reports and understand thenecessity <strong>of</strong> medical evaluation and importance <strong>of</strong> a multidisciplinary team approach totreating snoring and OSA.• Identify and describe the various treatment options available, focusing on the varioustypes <strong>of</strong> oral appliances available.• Describe the mechanisms <strong>of</strong> action <strong>of</strong> various types <strong>of</strong> oral appliances as well as theindications, contraindications, complications and side effects associated with their use.• Evaluate various case presentations that demonstrate a range <strong>of</strong> patients andtreatment situations representative <strong>of</strong> the practice <strong>of</strong> dental sleep medicine to includefabrication concepts, interpretation <strong>of</strong> bite registrations and adherence to recommendedtreatment protocol and standards <strong>of</strong> practice.• Apply practical concepts for building and developing a successful dental sleep medicinepractice, including an overview <strong>of</strong> informed consent, relationships with physicians,sources <strong>of</strong> patient referrals, follow-up with current patients, record keeping, and medicalinsurance billing.TEACHING METHODS<strong>The</strong> sessions at this course will be comprised <strong>of</strong> lectures followed by discussion.CONTINUING EDUCATION<strong>The</strong> <strong>American</strong> <strong>Academy</strong> <strong>of</strong> <strong>Dental</strong> <strong>Sleep</strong> <strong>Medicine</strong> is an ADA CERP Recognized Provider.ADA CERP is a service <strong>of</strong> the <strong>American</strong> <strong>Dental</strong> Association to assist dental pr<strong>of</strong>essionals inidentifying quality providers <strong>of</strong> continuing dental education. ADA CERP does not approveor endorse individual courses or instructors, nor does it imply acceptance <strong>of</strong> credit hoursby boards <strong>of</strong> dentistry. <strong>The</strong> <strong>American</strong> <strong>Academy</strong> <strong>of</strong> <strong>Dental</strong> <strong>Sleep</strong> <strong>Medicine</strong> designates thisactivity for 13.00 continuing education credits.Register online at www.aadsm.org


SESSION TIMESSaturday, November 127:00 AM – 7:45 AM* Continental Breakfast and Registration7:45 AM – 12:15 PM General Session12:15 PM – 1:15 PM* Lunch1:15 PM – 5:30 PM General SessionSunday, November 137:15 AM – 8:00 AM* Continental Breakfast8:00 AM – 1:15 PM General Session*<strong>The</strong>se 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 FACULTYOSA: Pathophysiology, Health Risks and Diagnosis with PolysomnographyKelly Carden, MD, MBAOSA: Medical Management with CPAP and Behavioral <strong>The</strong>rapiesKelly Carden, MD, MBADiagnostic Testing, including Airway Imaging, and Oral ExaminationR. Bruce Templeton, DMDOAT: Types and Mechanisms <strong>of</strong> ActionKathleen Bennett, DDSOAT: Titration <strong>of</strong> Mandibular Advancement Devices with Home <strong>Sleep</strong> Tests andin-lab PSG protocolsJames Metz, DDSOAT: Literature Review and Practice ParametersJeffrey Pancer, DDSOAT: Insertion, Adjustments, Side Effects and ComplicationsJames Metz, DDSAuxiliary Screening for <strong>Sleep</strong>-Related Breathing DisordersMegan Bacome, ROHOSA: MetabolismJeffrey Pancer, DDSSurgery for OSAJeffrey Prinsell, DMD, MDPractice Marketing and Patient Management: A Team ApproachRobert Rogers, DMDScope <strong>of</strong> Practice, Medico-legal Issues and ABDSM Board CertificationRobert Rogers, DMD and Jeffrey Prinsell, DMD, MDInsurance ReimbursementB. Gail Demko, DMDCase PresentationsSheri Katz, DDS, AADSM PresidentQuestions? Call the AADSM at (630) 737-9705


Speaker IndexMegan Bacome, RDHMs. Bacome is a JamesA. Rhodes State Collegealumnus. She earnedher Associates degree <strong>of</strong>Applied Science in <strong>Dental</strong>Hygiene, graduatingwith honors Phi <strong>The</strong>ta Kappa. Sheholds a vital role in screening for oralcancer, obstructive sleep apnea, routineprophylaxis and periodontal treatment.Ms. Bacome is certified to administerlocal anesthesia and is a provider forOral CDX Laboratories. She is authorizedto practice in general supervision. Sheis past president <strong>of</strong> SADHA and holdsmemberships with <strong>American</strong> <strong>Dental</strong>Hygienist Association, Ohio <strong>Dental</strong>Hygienist Association, & Columbus <strong>Dental</strong>Hygienist Association.Kathleen Bennett, DDSDr. Bennett is a graduate<strong>of</strong> Georgetown Universityand SUNY Buffalo <strong>Dental</strong>School, and she been inprivate practice restorativedentistry since 1983. Shewas the Program Committee Chair for theAADSM 16th Annual Meeting in 2007 andcurrently serves on the AADSM Board <strong>of</strong>Directors. She was a faculty member at theSUNY Buffalo School <strong>of</strong> <strong>Medicine</strong>’s sleepmedicine fellowship program and trainedmedical sleep fellows in clinical rotationsin her <strong>of</strong>fice from 2004-2006. Currentlyshe is practicing dental sleep medicineexclusively in a Cincinnati university-basedpractice and is affiliated with CincinnatiChildren’s Hospital where she treats SpinaBifida & Adult Down Syndrome patientswith OSA.Kelly Carden, MD, MBADr. Carden obtained herMD and MBA degrees atthe University <strong>of</strong> Tennesseeand continued her trainingin internal medicineat Baylor College <strong>of</strong><strong>Medicine</strong> in Houston. She then obtainedher Pulmonary/Critical Care and <strong>Sleep</strong><strong>Medicine</strong> fellowship training at HarvardMedical School. She is actively involvedin the AASM and the AADSM, serves as alecturer at a number <strong>of</strong> courses and sitson multiple committees. She is currentlyemployed with St. Thomas PhysicianServices in Nashville, Tennessee and isaffiliated <strong>The</strong> Center for <strong>Sleep</strong> which is anAASM-accredited laboratory.Steve Carstensen, DDSDr. Carstensen earned hisDDS from Baylor College <strong>of</strong>Dentistry in 1983 and is inprivate practice in Bellevue,WA. He has helpedhundreds <strong>of</strong> sleep apneapatients using oral appliance therapy,volunteers for organized dentistry for localand state dental societies and serves onthe Council for Annual Sessions for the ADAand the Board <strong>of</strong> Directors <strong>of</strong> the <strong>American</strong><strong>Academy</strong> <strong>of</strong> <strong>Dental</strong> <strong>Sleep</strong> <strong>Medicine</strong>.B. Gail Demko, DMDDr. Demko received herDDS from Boston Universityand was a hospital-baseddentist at Beth IsraelDeaconess Medical Centerin Boston for 20 years. In1997 she limited her dental practice to thetreatment <strong>of</strong> OSA and is an expert advisorto the FDA on oral appliance therapy. Sheis the President-elect <strong>of</strong> the AADSM andis a recipient <strong>of</strong> the AADSM DistinguishedService Award.Register online at www.aadsm.org


Speaker IndexRichard Finn, DDSDr. Finn is a Pr<strong>of</strong>essor,Department <strong>of</strong> Surgery,Division <strong>of</strong> Oral andMaxill<strong>of</strong>acial Surgery,Pr<strong>of</strong>essor, Department <strong>of</strong>Cell Biology/Anatomy, theUniversity <strong>of</strong> Texas Southwestern MedicalCenter in Dallas, Texas; and Chief <strong>of</strong> Oraland Maxill<strong>of</strong>acial Surgery at the VeteransHealth Care System North Texas- Dallas,TX. Dr. Finn has been actively teachinganatomy at UTSWMC since 1981. Dr. Finnhas been associated with treating OSASpatients since the early 1990s. He receivedthe Donald B. Osbon Award for OutstandingEducator in Oral & Maxill<strong>of</strong>acial Surgeryby the <strong>American</strong> Association <strong>of</strong> Oral &Maxill<strong>of</strong>acial Surgeons in 2008.Carla Hellekson, MDDr. Hellekson has beenpracticing Psychiatry and<strong>Sleep</strong> <strong>Medicine</strong> in thePuget Sound area since1989. Prior to that, shepracticed in Alaska inboth Anchorage and Fairbanks for 10years. Her areas <strong>of</strong> interest include thefull range <strong>of</strong> sleep disorders, especiallythe behavioral, dialectical behavioral, andpharmacological approaches <strong>of</strong> insomnia;light therapy for Seasonal Affective Disorderand Circadian Rhythm Disorders; adultand geriatric psychiatry; and contemplativepsychotherapy. Dr. Hellekson received hermedical training at Dartmouth MedicalSchool where she graduated with honors.She is a charter member <strong>of</strong> the Society forLight <strong>The</strong>rapy and Biological Rhythms, andnumerous other pr<strong>of</strong>essional organizations.She taught as Assistant Clinical Pr<strong>of</strong>essor <strong>of</strong>Psychiatry at the UW School <strong>of</strong> <strong>Medicine</strong> fortwenty years.Sheri Katz, DDSDr. Katz received her DDSfrom Emory Universityand practices within afamily practice in Decatur,Georgia. Her primaryinterest and focus <strong>of</strong>practice is dental sleep medicine. She hasserved on the AASM Standards <strong>of</strong> PracticeTask Force for OSA Surgery and is thePresident <strong>of</strong> the AADSM.Timothy Kitzmiller, DDSDr. Kitzmiller receivedhis DDS from Ohio StateUniversity College <strong>of</strong>Dentistry. Dr. TimothyKitzmiller has completedextensive post-graduatestudy in occlusion, aesthetics, and dentalsleep medicine. He is also a graduate<strong>of</strong> the renowned Las Vegas Institute forAdvanced <strong>Dental</strong> Studies, with particularemphasis on aesthetic reconstruction,smile rejuvenation, and neuromusculartherapy. Numerous hours <strong>of</strong> continuingeducation and having twice received theprestigious “Top Dentists in America”award keep Dr. Kitzmiller among an eliteclass <strong>of</strong> dentists.James Metz, DDSDr. Metz received his DDSfrom Ohio State University.He established a privatepractice after serving hiscountry for three years asa U.S. Army Major. He hasheld faculty appointments at both the OhioState University College <strong>of</strong> Dentistry andCase Western Reserve School <strong>of</strong> <strong>Dental</strong><strong>Medicine</strong>.Questions? Call the AADSM at (630) 737-9705


Speaker IndexJeffrey Pancer, DDSDr. Pancer received hisDDS from the University <strong>of</strong>Toronto, Canada. He runsa successful dental practicein Toronto. In addition togeneral dentistry, a largeportion <strong>of</strong> his practice is devoted to dentalsleep medicine and OAT. He has servedon the AASM Standards <strong>of</strong> Practice TaskForce for OAT. He is the Immediate PastPresident <strong>of</strong> the AADSM.Jeffrey Prinsell, DMD, MDDr. Prinsell received hisDMD from Tufts Universityand his MD from VanderbiltUniversity. He completed aGPR in Dentistry, a GeneralSurgery Internship andan OMS Residency at Vanderbilt. He is asurgical consultant at several metro-Atlantasleep centers and maintains an OMSprivate practice in Marietta, Georgia. He isa Diplomate <strong>of</strong> the ABOMS, has served onthe AASM Standards <strong>of</strong> Practice Task Forcefor OSA Surgery, is Chair <strong>of</strong> the AAOMS CIGon OSA Surgery, is Founding President <strong>of</strong> theABDSM and a Past President <strong>of</strong> the AADSM.Robert Rogers, DMDDr. Rogers received hisDMD from the University<strong>of</strong> Pittsburgh. He wasDirector <strong>of</strong> <strong>Dental</strong><strong>Medicine</strong> for St. BarnabasMedical Center inGibsonia, PA and is Director <strong>of</strong> ClinicalServices for Pittsburgh <strong>Dental</strong> <strong>Sleep</strong><strong>Medicine</strong>. He has a special interest inthe treatment <strong>of</strong> OSA and works withmany Pittsburgh area sleep centers.He served on the AASM Standards <strong>of</strong>Practice Task Force for OAT. He is theFounding President <strong>of</strong> the AADSM and isa recipient <strong>of</strong> the AADSM DistinguishedScientist Award.David Schwartz, DDSDr. Schwartz has beena practicing generalrestorative dentist since1988 and has expertisein all fields <strong>of</strong> dentistrywith a concentration indental sleep medicine for the last 12years. He has educated dentists aroundthe world on the benefits <strong>of</strong> dental sleepmedicine and has lectured at variousstudy clubs and dental organizationsincluding LVI, Northwest Indiana <strong>Dental</strong>Society, Chicago <strong>Dental</strong> Society, ItamarCorporation and Somnomed. He serves onthe Insurance Reimbursement Committeefor the <strong>American</strong> <strong>Academy</strong> <strong>of</strong> <strong>Dental</strong><strong>Sleep</strong> <strong>Medicine</strong>, and is a Diplomate <strong>of</strong> the<strong>American</strong> Board <strong>of</strong> <strong>Dental</strong> <strong>Sleep</strong> <strong>Medicine</strong>.He is currently director <strong>of</strong> <strong>Dental</strong> <strong>Sleep</strong><strong>Medicine</strong> at <strong>The</strong> Center for <strong>Sleep</strong><strong>Medicine</strong>’s Chicagoland locations.R. Bruce Templeton, DMDDr. Templeton received hisDMD from the University<strong>of</strong> Manitoba, Canadaand completed an OMSResidency at the University<strong>of</strong> Minnesota. He is aDiplomate <strong>of</strong> the ABOMS, past Chief <strong>of</strong>Surgery at Northern Memorial MedicalCenter, past Chief <strong>of</strong> Dentistry at MNChildren’s Medical Center, Chief <strong>of</strong> OMSat the VA Hospital in Minnesota, ClinicalPr<strong>of</strong>essor at the University <strong>of</strong> MinnesotaFaculty <strong>of</strong> Dentistry, Vice President <strong>of</strong>the Minnesota <strong>Dental</strong> Association andPresident <strong>of</strong> the Minnesota Society <strong>of</strong>OMS. He has served on the AADSM Board<strong>of</strong> Directors.Register online at www.aadsm.org


GENERAL INFORMATIONLOCATION & ROOM RESERVATIONS<strong>The</strong> courses will be held at the AADSMNational Office, 2510 North FrontageRoad, Darien, Illinois 60561. <strong>The</strong> AADSMhas reserved a block <strong>of</strong> guest rooms atthe Chicago Marriott Southwest at BurrRidge, 1200 Burr Ridge Parkway, BurrRidge, Illinois 60527, at a special grouprate. Space is limited, so please makereservations well in advance. <strong>The</strong> roomrate at the hotel is $111.00 per night plustax and is only valid until Friday, October14, 2011, or until the room block sells out.Reservations must be made by individualattendees directly with the hotel’sreservation department by calling 630-986-4100. To receive the special grouprate, you must identify yourself as part <strong>of</strong>the AADSM course group. Check-in time is4:00pm and check-out time is 11:00amon the day <strong>of</strong> departure.Midway is approximately 18 miles fromthe <strong>of</strong>fice. Because you will be traveling toa suburb, we recommend that you do notpick-up a taxi outside <strong>of</strong> the baggage claimexit as these taxis will charge at 1.5 timesthe metered rate to take you to the hotel.Rather, after you pick-up your baggage atthe airport, contact 303 Taxi via phone at(847) 256-8294 and provide them with theaccount number 6307379700. Taxi serviceto and from the airport is approximately$40.00 each way, not including gratuity.Please anticipate 30-40 minutes for traveltime to and from either airport.CONFIRMATION Confirmations willbe sent via e-mail within one week<strong>of</strong> receipt <strong>of</strong> registration form andpayment. All participants must preregisterfor courses; on-site registrationwill not be accepted.TRANSPORTATION - from Hotel toNational Office Shuttle service will beprovided to and from the Chicago MarriottSouthwest at Burr Ridge to the AADSMNational Office prior to and at the end<strong>of</strong> the day on each day <strong>of</strong> a course.Transportation to any other location or atany other time is the responsibility <strong>of</strong> theattendee. Details regarding the shuttleschedule will be sent to attendees viae-mail in advance <strong>of</strong> the course.MEALS Breakfast and lunch will beserved on Saturday, and breakfast willbe served on Sunday; all other meals arethe responsibility <strong>of</strong> the attendees. Onlyregistered attendees are allowed to attendmeal functions. Guests <strong>of</strong> attendeeswill not be accommodated during mealfunctions.TRANSPORTATION Attendees maycontact Corporate Travel to purchaseairline tickets. Call toll-free (800) 526-4540 on Monday-Friday from 8:00am-5:00pm Central. We suggest you makeyour travel arrangements as soon as youreceive your registration confirmation.<strong>The</strong> airports nearest to the AADSM NationalOffice are O’Hare International Airportand Midway International Airport. O’Hareis approximately 23 miles from the <strong>of</strong>fice.<strong>The</strong> AADSM will not be held liable ifan individual purchases an airlineticket before receiving confirmation <strong>of</strong>registration for this course.CANCELLATION & REFUND POLICYTo cancel a registration, writtennotification must be submitted tothe meeting department. A $50.00administrative fee will be withheld oncancellations postmarked prior to Friday,October 21, 2011. After this date, norefunds will be available. Refunds arenot provided to no-shows. <strong>The</strong> AADSMreserves the right to cancel the courseand provide a full refund should conditionswarrant. <strong>The</strong> refund will only include thecost <strong>of</strong> registration for the course.RECORDING Photographing and/or recording, <strong>of</strong> any kind, <strong>of</strong> sessionsand speakers at its courses are strictlyprohibited.DRESS CODE Dress code at the coursesis business casual.INFORMATION OR QUESTIONSFor information or questions regarding thecourses, please contact:Randi Prince, AADSM CoordinatorE-mail: rprince@aadsm.orgWebsite: www.aadsm.orgQuestions? Call the AADSM at (630) 737-9705


REGISTRATION INSTRUCTIONShow toregisterOnline (credit card only)www.aadsm.orgFax (credit card only)(630) 737-9790Mail (check or credit card)<strong>American</strong> <strong>Academy</strong> <strong>of</strong> <strong>Dental</strong> <strong>Sleep</strong> <strong>Medicine</strong>2510 North Frontage RoadDarien, IL 60561-1511Registration DisclaimerRegistration is limited. Please register early. Confirmation letters will be sent viae-mail within one week <strong>of</strong> receipt <strong>of</strong> registration form and payment. All attendeesmust pre-register; on-site registration will not be accepted.<strong>The</strong> AADSM will not be held liable if an individual purchases an airline ticket beforereceiving confirmation <strong>of</strong> registration for these courses.Registration CategoriesMemberTo register as a member, the registrantmust currently be an individual member<strong>of</strong> the <strong>American</strong> <strong>Academy</strong> <strong>of</strong> <strong>Dental</strong><strong>Sleep</strong> <strong>Medicine</strong> (AADSM). If the AADSMis unable to confirm that the individual isa member <strong>of</strong> the society, the AADSM willregister the individual as a nonmemberat the prevailing fee.Student MemberTo register as a student member, theregistrant must currently be a studentmember <strong>of</strong> the AADSM. If the AADSMis unable to confirm that the individualis a student member <strong>of</strong> the society, theAADSM will register the student as anonmember at the prevailing fee.<strong>Dental</strong> Staff <strong>of</strong> AADSM MemberTo register as the dental staff <strong>of</strong> anAADSM member, the registrant mustcurrently be employed by an individualwho is currently a member <strong>of</strong> theAADSM. If the AADSM is unable toconfirm that the dentist is a member<strong>of</strong> the AADSM, the AADSM will registerthe individuals as a dental staff <strong>of</strong> anonmember at the prevailing fee.NonMemberWant to register for the member price,but you’re not a member? Join theAADSM to receive instant savings includingreduced course registration fees, a listingon the Find-a-Dentist feature <strong>of</strong> the AADSMwebsite, subscriptions to <strong>Sleep</strong> andBreathing and Dialogue and much more.Visit the AADSM website at www.aadsm.orgfor more information about membershipincluding a complete list <strong>of</strong> benefits and adescription <strong>of</strong> all membership categories.Membership is on a calendar-year basis(January 1–December 31). On June 1,2011, the membership dues for RegularMembers are prorated. Membership duesfor 2011 are:<strong>Dental</strong> Staff <strong>of</strong> NonmemberIf your employer is not an individualmember <strong>of</strong> the AADSM and wouldlike to become a member, pleaserequest that he or she completesthe membership application formavailable at www.aadsm.org. Visit theAADSM website at www.aadsm.org formore information about membershipincluding a complete listing <strong>of</strong> benefits.Register online at www.aadsm.org


REGISTRATION FORM (please type or print clearly)Full Name:Degree(s):(This is the name that will be on your name badge)Address:City: State: Zip/Postal Code:Country:Fax:E-mail:Special Needs/Accommodations:Phone:(e-mail required to receive confirmation)Attendee List Permission (Check one)I give my permission to include my contact information on an attendee list to be distributed tocourse attendees. Yes NoExhibitor List Permission (Check one)I give my permission to include my contact information on an attendee list to be distributed tocourse exhibitors. Yes No2011 Membership Dues for Nonmembers (Check one)Want to register for the member price, but you’re not a member? Join the AADSM today to receiveinstant savings on your registration fee! Membership dues are based on the date that the registrationis recieved by the AADSM national <strong>of</strong>fice. 2011 Memberships will be vailid through December 31,2011; 2012 memberships will be valid through December 31, 2012.2011 Membership 2012 MembershipRegular Members $175 $345Student Members Free with completion <strong>of</strong> AADSM Student Application.Registration Fees (Check one) Introduction to <strong>Dental</strong> <strong>Sleep</strong> <strong>Medicine</strong> Course – November 12-13, 2011 – Darien, Illinois Advanced <strong>Dental</strong> <strong>Sleep</strong> <strong>Medicine</strong> Course – November 12-13, 2011 – Darien, IllinoisOn or before 10/14/11 After 10/14/11AADSM Member $550 $650AADSM Student Member $425 $525<strong>Dental</strong> Staff <strong>of</strong> AADSM Member $425 $525Name <strong>of</strong> AADSM MemberNonmember $650 $750<strong>Dental</strong> Staff <strong>of</strong> Nonmember $525 $625 I attended the AADSM 20 th Anniversary Meeting and will save $100 on my registration fee!**By checking this box the registration fee will be reduced by $100.Method <strong>of</strong> Payment Please make checks payable to the AADSM (U.S. funds drawn on a U.S. bank) For payment by credit card (VISA/MasterCard/<strong>American</strong> Express):Card#:Exp. Date: / Validation Code * :Cardholders Name:Detach and ReturnMailing Address:Signature: Date: /*For a VISA or MasterCard, the validation code is the last 3 numbers in the signature box. For an <strong>American</strong> Express, the validation code is the4 numbers above the credit card number.Questions? Call the AADSM at (630) 737-9705


AMERICAN ACADEMY OF DENTAL SLEEP MEDICINE2510 North Frontage RoadDarien, Illinois 60561-1511Fall 2011E d u c a t i o n a l c o u r s e sADVANCED DENTAL SLEEP MEDICINEINTRODUCTION TO DENTAL SLEEP MEDICINENovember 12-13, 2011AADSM National OfficeDarien, IllinoisRegister online at www.aadsm.org

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