2012 review notice registration form


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2012 review notice registration form

  1. 1. Bender–Seltzer– Grossman Academic Review of Endodontology FRIDAY, SEPTEMBER 21 - SUNDAY, SEPTEMBER 23, 2012This 2½ day program provides an intensive review of the biologic foundations of Endodontology. World-renownedfaculty will present the latest evidence-based information within their respective fields.This course is designed to be an ideal review for candidates taking either the Written or the Oral Boards, but it will alsogreatly benefit all those interested in Endodontics; students, faculty, specialists and generalists.Faculty and Program: CE CREDITS: 17 HOURSFrederic Barnett, DMD: Chair and Program Director, I.B. Bender Division of FOR MORE INFORMATIONEndodontics, Einstein Medical Center, Philadelphia, PA – “Root Resorption” Contact Clarissa CrawfordPaul Duncan Eleazer, DDS, MS: Professor and Chair, Department of Endodontics crawforc@einstein.eduand Pulp Biology, University of Alabama at Birmingham – “Mock Orals” 215-456-6620Elliot V. Hersh, DMD, MS, PhD: Professor of Oral Surgery and Pharmacology and LOCATION:Director of Division of Pharmacology and Therapeutics, University of Pennsylvania, Philadelphia City Avenue HiltonSchool of Dental Medicine, Philadelphia, PA – “Antibiotics & Pharmacology” 4200 City AvenueG. Rex Holland, BDS, PhD: Professor of Cariology, Restorative Sciences and Philadelphia, PA 19131Endodontics, University of Michigan, Ann Arbor, MI – “Pulp Biology” philadelphiacityavenue.hilton.comGeorge Huang, DDS. MSD, DSc: Chair and Professor and Director of Postgraduate HOTEL RESERVATIONS:Programs in Endodontics, Boston University School of Dental Medicine, Boston, MA – For accommodations, contact“Pathogenesis of Bone Resorption” and “Stem Cells & Regenerative Endo” michael.fitzgerald@hilton.comJeffrey Hutter, DMD, MEd: Dean, Boston University, Boston, MA – “Fascial Space or call Michael Fitzgerald @Infections” 215-879-3399 x2016 and reference the Einstein DentalAsma A. Khan, BDS, PhD: Assistant Professor of Endodontics, University of North Medicine “Academic ReviewCarolina, Chapel Hill, NC – “Mechanisms and Pain” and “Anesthesia and PainControl” Course” for corporate rate of $135/night.Gordon A. Pringle, DDS, PhD: Professor of Pathology and Laboratory Medicine,Temple University School of Medicine, Philadelphia, PA – “Oral Pathology” PARKING: Self-parking is availableChristine Sedgley, MDS, MDSc, PhD: Associate Professor and Chair, Department at the hotel for $5.00 a day.of Endodontology, Oregon Health and Science University, Portland, OR –“Endodontic Microbiology” HOSTED BYRepresentative from American Board of Endodontics, Chicago, IL – “‘Boardwalk’Board Review”Course Director:Frederic Barnett, DMD, Interim Department Chairman, Maxwell S. FogelDepartment of Dental Medicine, Chair and Program Director, I.B. Bender Division ofEndodontics, Einstein Medical Center, Philadelphia, PA
  2. 2. BENDER-SELTZER-GROSSMAN ACADEMIC REVIEW OF ENDODONTOLOGY FRIDAY, SATURDAY & SUNDAY SEPTEMBER 21-23, 2012 Registration FormTuition: Early Late (before 9/4/2012) (after 9/4/2012)Endodontist $725.00 $795.00Full-time Faculty $350.00 $450.00Military $350.00 $450.00Full-time Resident $250.00 $350.00Tuition includes continental breakfast each day and buffet lunch on Friday and Saturday.Name______________________________________________________________, DDS / DMDAcademic Affiliation: ○Faculty ○Student ○NoneInstitution____________________________________________________________________Address ___________________________________________________________________________________________________________________________________________________City, State, Zip________________________________________________________________Phone _______________________________________________________________________Fax _________________________________________________________________________E-mail _______________________________________________________________________Present Position_______________________________________________________________Amount Enclosed $________________________○Check ○Visa ○AMEX ○MasterCard ○Discover(Payable to “EMC -Dental Medicine”)Card No. _____________________________________________________Exp Date:________________Name on Card____________________________________Signature_____________________________ (please print)Registration: To register, completed forms can be sent via email: crawforc@einstein.edu;fax: 215-456-3482; or mailed to: Clarissa Crawford, Department of Dental Medicine, Einstein MedicalCenter, 5501 Old York Road, Philadelphia, PA 19141, tel: 215-456-6620.Cancellation and Refund Policy: Cancellations received before September 4, 2012 will be refundedminus a $50 administrative fee. Cancellations received after September 4, 2012 will be refunded 50% of thefee. No refunds will be issued after September 10, 2012.