Registration Form

• Apr 15 2011
• Patrick Roetzer, D.D.S., F.I.C.D.
• "Clinical Jewels You Can Count On"


• ~ 9:00 am to 3:00 pm ~
• Red Bluff Community Center 1500 South Jackson St. Red Bluff, CA
• Phone: (530) 527-6764

Participants

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• No refunds after April 13. $15 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 6 units of C.E. credits

Method of Payment:

[ ] Credit Card [ ] Check
• [ ] Visa [ ] MasterCard
Expiration Date: MM/YY _____/______ Name of Cardholder (please print) ___________________________________________________
• Card # [ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ]
• Make Checks payable to:
• NCDS
• P.O. Box 9265
• Red Bluff, CA 96080
• Phone: 527-6764
• FAX: 527-7911

Comments

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• Courses that you take on Friday should make your Monday better! Dr. Roetzer will give you clinical jewels you can count on!