Join us in Toronto... Registration Form Name: _______________________________________________________ Address: _____________________________________________________ City: _____________ SOFT TISSUE GRAFTING FOR TEETH & IMPLANTS Province: _______ Postal Code: ______________ Phone: ______________ Fax: _________________ Email: ____________ Doctor’s Fee: $4,500.00 CAD + 13% HST = $5,085.00 CAD x ______ Auxiliary Fee: $795.00 CAD + 13% HST = $ 898.35 CAD x ______ Total Fee: _______________________ A non-refundable deposit of $500.00 will be charged upon registration. The balance will be charged 21 days prior to the course. Fees are charged in Canadian Dollars Please select one: Cheque Visa Mastercard Card Holder’s Name: ___________________________________________ 416.566.9855 www.torontoimplantinstitute.com Signature: ___________________________________________________ I agree to pay the above Course Fee according to the card issuer agreement. Payment will be applied to the credit card provided upon registration Please make cheques payable to the Toronto Implant Institute Inc. Mail: Email: Ph: 300 York Mills Road, Suite 207 Toronto, ON M2L 2Y5 [email protected] 416.566.9855 The Toronto Implant Institute Inc. has been designated an approved Program Provider by the Ontario constitutent of the Academy of General Dentistry. This Program Provider’s formal CDE programs are accepted by the AGD for membership maintainence., Fellowship and Master ship credits. The current term of approval extends from November 1, 2011 to October 31, 2014. Refunds/Cancellations: Cancellations must be made in writing at least 30 days prior to the course. The deposit of $500.00 will be forfeited. The Toronto Implant Institute reserves the right to program cancellation if attendance is insufficient. Participants will be notified if a program is cancelled or rescheduled six weeks prior to the course date. In any event, the Toronto Implant Institute will not be responsible or liable for expenses incurred by the registrant. April 24 - 25, 2015 REGISTER EARLY!! LIMITED ATTENDANCE 207 - 300 York Mills Road Toronto, ON M2L 2Y5 Expiry Date: _________ Card Number: _________________________ Presented by: Dr. Edward P. Allen About the Speaker Dr. Allen is past president of the American Academy of Esthetic Dentistry, the American Academy of Restorative Dentistry and the American Academy of Periodontology Foundation. He currently serves as the Periodontal Section Editor for the Journal of Esthetic Dentistry and serves on the Editorial Boards of the Journal of Periodontology and the International Journal of Periodontics & Restorative Dentistry Dr. Allen received the Distinguished Alumnus Award from the Baylor College of Dentistry Periodontics Residency Program, the Master Clinician Award from the American Academy of Periodontology and the Best Teacher Award from the American Academy of Esthetic Dentistry. Dr. Allen is Founder and Director of the Center for Advanced Dental Education in Dallas, Texas where he teaches surgical technique courses. He has published over 50 articles in the area of esthetic surgery and continues to present numerous lectures and surgical demonstrations worldwide. Course Objectives Course Details This unique two-day learning event will reveal the latest advances in minimally invasive Oral Plastic Surgical procedures. Date Friday, April 24 - Saturday, April 25, 2015 Cost Dr. Allen will discuss AlloDerm Regenerative Tissue Matrix as a safe and effective alternative to palatal tissue for the treatment of soft tissue deficiencies around teeth and dental implants, single- and multiple-tooth soft tissue ridge augmentation, and vestibular extension. You will learn the latest micro-surgical instrumentation, current suturing techniques and the rational for use of PRP (Platelet Rich Plasma). Hands-on exercises with an illustrated step-by-step procedural manual will help you immediately incorporate these procedures into your practice. Attendees will learn: • • • • • Keys for successful soft tissue grafting Minimally invasive microsurgical instrumentation Specialized suturing techniques Rationale and technique for using PRP Current clinical research findings $4,500.00 + 13% HST per attendee $795.00 + 13% HST per auxiliary Location TBA Time 8:00am to 5:00pm Breakfast, Buffet Lunch and Snacks provided