REGISTRATION FORM
“Life in the Balance: Strategies for Optimal Health”
“ Top Selling Dietary Supplements: A Review of the Evidence”
Dr. Tieraona Low Dog, M.D.
October 12, 2007
 9:00am - 4:00pm
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 October 10th   $5 extra for all registration at the door.
( ) $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
Phone: 527-6764
FAX: 527-7911


Name of Cardholder (please print)
___________________________________________________

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



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Dr. Low Dog spoke at the CDA a few years back. Her morning session started only half full. By noon there were just a few seats. Her afternoon session was full 30 minutes prior to the start of the lecture with people standing in line hoping to get in. I have never seen this type of response before. Her lecture was excellent and I expect no less when she presents to us.

-Dr. Mike Viale