How to Register 1. On-line www.scdaannualsession.com/registration 2. Fax your registration form (front & back) with credit card payment to 817-277-7616 3. Mail the registration form with payment to: 2010 SCDA Annual Session c/o Custom Registration 2020 E. Randol Mill Road Suite 307 Arlington, TX 76011 Questions? Call 877-205-1943 between the hours of 8:00 am – 5:00 pm central time or email [email protected]. Special Needs: If you require special assistance, please contact [email protected] as soon as possible in advance of the meeting so appropriate arrangements can be made. Alcohol Policy: In South Carolina, the minimum age for the consumption of liquor, beer and wine is 21 years of age. SCDA's official policy is to respect the drinking age restrictions set by the jurisdiction where an event takes place. Confirmation Packets: Confirmation packets, to include badges, will be mailed to pre-registered conference attendees starting at the end of March. If you do not receive yours or have changes, please contact our registration company at the phone number or email address above. All registrations processed after April 20, will need to pick-up their materials on-site. Cancellations: If you should have to cancel, refunds for registration will be made less a $25 administration fee upon receipt of written request received by fax or email on or before March 26. No refunds will be issued after that date and all refunds will be processed after the conference. Cancellation notices should be communicated to SCDA in writing by faxing the written notification to 803-750-1644, via e-mail to [email protected] or mailing written notification to Deanna Slomzenski, SCDA, 120 Stonemark Lane, Columbia, SC 29210. If you have further questions regarding the cancellation, please call Deanna Slomzenski toll free in SC at 1-800-327-2598 or outside SC at 803-750-2277. Payment Section: Registration Fee Total $______________ Session & Event Ticket Price Total $_________________ Total Charge $_________________ Check or Money Order (Payable to the South Carolina Dental Association) Visa MasterCard Discover AMX Credit Card # _______________________________________ Exp. Date: _________ V Code* _____________ number found on the far right of the backside of VISA, * 3-digit MasterCard and Discover cards 4-digit number found on the front right side of American Express Signature: _________________________________________________________________________________ Print Name : _______________________________________________________________________________ (as it appears on the credit card) I. Registration – one form per person (please print or type) Registration Type:______________________________________ * Registration fee includes admittance to the Thursday welcome reception & beach dance, exhibit hall and most general sessions. Registration Type SCDA Member Out-of-State ADA Member ADA Non-Member Dentist SCDLA Member, Military & Out-of-State CDT SCDLA Non-Member Hygienist Dental Assistant Business Assistant Full-Time Faculty Spouse of Dentist Guest MUSC Dental Student Hygiene Student Dental Assistant Student SCDA or ADA Retired Voluntary Gift to Sponsor Dental Student By 3/26 150.00 250.00 450.00 125.00 250.00 50.00 50.00 50.00 Free Free Free Free Free Free Free 35.00 After 3/26 210.00 350.00 510.00 150.00 275.00 60.00 60.00 60.00 25.00 25.00 25.00 Free Free Free Free 35.00 Registrant Name: _____________________________________________________________________________ Company/Name of Practice: ____________________________________________________________________ Address: ____________________________________________________________________________________ City: __________________________________________________ State: ___________ Zip: _________________ Phone: _________________________________________________ Fax: ________________________________ E–Mail: _____________________________________________________________________________________ By providing your email address, you grant SCDA permission to contact you via email regarding your registration as well as to receive updates and/or promotional materials from this conference. Your e-mail address will not be given to any third party. Photographs of the attendees may be used in future publications including but not exclusive to the website, ads, invitations and brochures. II. Ribbons Needed: (mark all that apply) ___Alternate ___Board Member ___Convention Committee ___DAD Volunteer ___Delegate ___ DenPac ___Designated Buyer___GKAS Volunteer ___Executive Committee ___ Faculty ___New Member ___ Palmetto Club ___Past President ___ Pinnacle Club ___Speaker ___Student Sponsor ___ Student III. Accommodations: Are you staying at the Kingston Plantation? Yes No IV. Session Registration & Special Events Please indicate the sessions or events you plan to attend. Thursday, April 29 7:30 am – 8:30 am 9 am – 12 pm 9:30 am – 12 pm 12 pm – 2 pm 2 pm – 5 pm 4 pm – 5 pm 5 pm – 6:30 pm 8 pm – 11 pm T01 Past Presidents’ Breakfast Prescription Drug Abuse & Meth Mouth - What's Cooking in Your Office T02 SCDA House/General Membership Meeting T03 T04 $35 SCDA Awards Luncheon Recognizing and Reporting Abuse and Neglect - You and the Law T05 Pharmacotherapy Review for Dentists: a Focus on Antibiotics and Narcotisc T06 T07 SCDA Town Hall Meeting T08 Welcome Reception in the Exhibit Hall T09 Beach Dance - Featuring the Ninth Row Band Friday, April 30 8 am – 12 pm 8:30 am – 11:30 am 9 am – 10:30 am 11:30 am – 1 pm 12 pm – 1 pm 1 pm – 5 pm 1 pm – 3 pm 2 pm – 4 pm 3 pm – 5 pm 5 pm – 6 pm 5 pm – 7 pm 6:30 pm – 9:30 pm F01 $60 CPR Recertification (limited to 35) Removable Prosthodontics - Increased Demand in the Modern World Sponsored by SCDLA F02 Bread and Butter Adhesive and Esthetic Dentistry F03 Teenagers - What Their Mouths are Telling You but They're Not: F04 Practical Information on Teen Health Issues Sponsored by Philips Sonicare F05 Alliance Drop-in F06 $30 Dental Team Luncheon with SCCDH F07 $35 MUSC, ACD, ICD & PFA Luncheon F08 SCDLA Members Business Meeting & Luncheon F09 $60 CPR Certification (limited to 35) Full Contour Zirconia Fabrication on Implant & Abutment Level Restorations F10 Sponsored by ZirkonZahn USA Bread and Butter Adhesive and Esthetic Dentistry (continued from AM session) F11 Customized Care for Healthy Patients and a Healthy Practive Sponsored by Philips Sonicare F12 Improve Productivity with Precise Digital Impressions F13 Sponsored by 3M ESPE F14 SC Society of Pediatric Dentistry General Meeting F15 State Board Drop-In F16 Pediatric Drop-In F17 MUSC/New Dentist Drop-In Sponsored by Patterson Dental Supply F18 SCDAA Sun and Sand Social F19 SCDLA Reception F20 $40 Low Country Dinner and Social being held at the Historic Myrtle Beach Train Depot Saturday, May 1 7:30 am – 9 am 8 am – 9 am 8 am – 9:30 am 9 am – 12 pm 9:15 am – 10:30 am 10 am – 12 am 12 pm – 2 pm 1 pm – 5:30 pm 1 pm – 4 pm S01 $24 DenPac Breakfast Updates to the South Carolina Medicaid Dental Progam S02 Infection Control for the Dental Laboratory (lab registrants only) Sponsored by SCDLA S03 S04 SCDAA Breakfast S05 $25 OSHA Update for the Dental Office (all proceeds are dontated by Dr. Hook to MUSC) Practical Laser Assisted Dentistry S06 Sponsored by Biolase Esthetic Solutions for Today and Tomorrow S07 Sponsored by Ivoclar Vivadent S08 DenPac Board Meeting S09 SCDAA Business Meeting S10 SCDLA Awards Luncheon ($30 for non-registered lab attendees) S11 $120 Golf Tournament at Pine Lakes Country Club The Essentials of Restoratively Driven Esthetic Implant Dentistry Sponsored by Astra Trech, Inc. S12 Sunday, May 2 8 am – 12 pm S13 SCDLA CDT Exam Registrant Name: _____________________________________________________________________________