ARK-LA-TEX
ARK-LA-TEX
ACADEMY OF DENTISTRY
806 Medical Circle #200
Longview, TX 75605
Registration (903) 753-0337
Fax (903) 236-4537
THE ARK-LA-TEX ACADEMY OF DENTISTRY
PRESENTS
REGISTRATION FORM FOR
BREAD AND BUTTER ADHESIVE AND ESTHETIC DENTISTRY
BY
HAROLD HEYMANN
FRIDAY, FEBRUARY 19, 2010
CLARION HOTEL
SHREVEPORT, LOUISIANA
PROMPT STARTING TIME 8:30 AM
7 HOURS CONTINUING EDUCATION LECTURE CREDIT
REGISTRATION TO BE RECEIVED NO LATER THAN
5 DAYS PRIOR TO SEMINAR.
TO REGISTER YOU MUST MAIL OR FAX THIS COMPLETED FORM TO:
DR. CLINT BRUYERE, D.D.S.
806 MEDICAL CIRCLE #200
LONGVIEW, TX 75605
FAX (903) 236-4537
(Print Name)________________________________ [ ] I WILL ATTEND [ ] I WILL NOT ATTEND
PHONE: ______________________________
THESE STAFF MEMBERS WILL ATTEND:
1. ________________________________________
2. ________________________________________
3. ________________________________________
4. ________________________________________
5. ________________________________________
Dr. Non-Member Fee: $245 (Non-refundable-$45 if not received by deadline) Enclosed is my check for
Staff/Lab Tech (each): $35 (Non-refundable-$45 if not received by deadline) $____________.
The Ark-La-Tex Academy of Dentistry is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of the program provider are accepted by AGD for Fellowship, Mastership, and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry. The current term of approval extends from October 19, 2003-October 18, 2006.
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.