REGISTRATION FORM
Shared Secrets: Enhance Your Practice with Esthetic Dentistry’s
“ Best Kept Secrets”
John W. Farah, D.D.S. PhD
September 14, 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 September 12th   $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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Comments

CRA, Reality and the Dental Advisor are the three major review organizations in dentistry. Dr. Farrah is in charge of the Dental Advisor and as such has a wealth of knowledge to share. This should be an informative and beneficial day for all of us.