REGISTRATION FORM
“Doctors and Hygienists – You are a Team”
Unleash the Comprehensive Potential in your Practice”
Dr. Lou Graham D.D.S.
April 11, 2008
 9:00 a.m. - 4:00 p.m.
 Phone: (530) 527-6764

Red Bluff Community Center 1500 South Jackson St. Red Bluff, CA
Participants
D.D.S.
PHONE:
RDA

RDH
OTHER DHP
No refunds after April 9th.   Dentist Late fee $15 and Auxiliary late fee $10
( ) $125 per CDA/ADA member dentist. Lunch included.
( ) $ 55 per RDA/RDH/Other Dental Health Professional. Lunch included
( ) $225 per non-CDA/ADA member dentist. Lunch included
Total 7 units of C.E. credits
Method of Payment

[ ] Check




Credit Card
[ ] Visa [ ] MasterCard

Expiration Date: MM/YY

_____/______
Make payable to: NCDS
P.O. Box 9265
Red Bluff, CA 96080


Name of Cardholder (please print)
___________________________________________________

Card # [ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ]



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Comments

Dr. Graham is a very enthusiastic informational speaker. He is knowledgeable and presents periodontal treatment in a way that motivates both patients and clinicians.