How to Register 1. On-line www.scdaannualsession/register.com (recommended) 2. Fax your registration form (front & back) with credit card payment to 817-277-7616 3. Mail the registration form with payment to: 2012 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 a.m. - 5:00 p.m. central time or email [email protected]. Confirmation Packets Confirmation packets, to include badges, tickets and ribbons, 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 23. 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 800-327-2598 or outside SC at 803-750-2277. 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. Payment Section: Registration Fee Total $_________________ Session & Event Ticket Price Total $_________________ Total Charge $_________________ Check or Money Order (Payable to the South Carolina Dental Association) Circle One: Visa MasterCard Discover AMX Credit Card # _____________________________________ Exp. Date: _________ V Code* __________ Signature: ______________________________________________________________________________ ! Print Name : ____________________________________________________________________________ (as it appears on the credit card) *3-digit number found on the far right of the backside of VISA, MasterCard and Discover cards. 4-digit number found on the front right side of American Express I. Registration – one form per person (please print or type) * Registration fee includes admittance to the Thursday Welcome Reception, Friday Ice Cream Social, exhibit hall and most general sessions. Registration Type By 3/23 On/After 3/23 SCDA Member 150.00 210.00 Out-of-State ADA Member 250.00 350.00 ADA Non-Member Dentist 450.00 510.00 SCDLA Member, Military & Out-of-State CDT 125.00 150.00 SCDLA Non-Member 250.00 275.00 Hygienist 50.00 60.00 Dental Assistant 50.00 60.00 Business Assistant 50.00 60.00 Full-Time Faculty Free 25.00 Spouse of Dentist Free 25.00 MUSC Dental Student Free Free Hygiene Student Free Free Dental Assistant Student Free Free SCDA or ADA Retired Free Free Registration Type: _______________________________________________________________________ Registrant Name: ________________________________________________________________________ Company/Name of Practice: ______________________________________________________________ Title: ___________________________________________________________________________________ Address: ________________________________________________________________________________ City: _________________________________________________ State: ___________ Zip: _____________ Phone: ______________________________________________ Fax: _______________________________ E–Mail: _________________________________________________________________________________ Emergency Contact Name: _______________________________________________________________ Emergency Contact Relationship: __________________________________________________________ Emergency Contact Phone: _______________________________________________________________ Please indicate here if you have a disability and require special accommodations. ________________________________________________________________________________________ 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 Delegate ___Board Member ___Convention Committee ___DAD Volunteer ___Delegate ___ DenPac ___Designated Buyer ___Disaster Relief ___Executive Committee ___ Faculty ___Foundation ___GKAS Volunteer ___New Member ___ Palmetto Club ___Past President ___ Pinnacle Club ___Speaker ___ Student ___Student Sponsor III. Accommodations: Are you staying at the Kingston Plantation? IV. Sponsorship: Yes No ___ Voluntary Gift to Sponsor Dental Student (35.00) V. Session Registration & Special Events Please indicate the sessions or events you plan to attend. All educational sessions are valid for continuing education credits. Thursday, May 3rd 7:30 a.m. - 8:30 a.m. 8:30 a.m. - 10:30 a.m. 9:00 a.m. - 12:00 p.m. 12:00 p.m. - 2:00 p.m. 2:00 p.m. - 4:30 p.m. 4:30 p.m. - 5:00 p.m. 4:30 p.m. - 6:00 p.m. Friday, May 4th 6:30 a.m. - 8:30 a.m. 7:30 a.m. - 8:30 a.m. 8:00 a.m. - 4:00 p.m. 8:00 a.m. - 12:00 p.m. 8:30 a.m. - 9:30 a.m. 9:00 a.m. - 12:00 p.m. 9:00 a.m. – 10:30 a.m. 9:30 a.m. - 11:30 a.m. 12:00 p.m. - 1:30 p.m. 12:00 p.m. - 1:00 p.m. 1:00 p.m. 1:00 p.m. - 3:00 p.m. 1:00 p.m. - 5:00 p.m. 1:30 p.m. - 4:30 p.m. 2:00 p.m. - 4:00 p.m. 2:30 p.m. - 3:30 p.m. 3:00 p.m. - 5:00 p.m. 4:30 p.m. - 5:30 p.m. 6:00 p.m. - 10:00 p.m. Saturday, May 5th 7:30 a.m. - 9:00 a.m. 8:00 a.m. - 9:00 a.m. T01 T02 T03 T04 T05 T06 T07 T08 T09 House of Delegates Meeting Guest Speaker: Dr. William R. Calnon, ADA President SCDA Board Meeting Non-Odontogenic Toothaches Speaker: Dr. Jeff Okeson Increasing Treatment Acceptance Speaker: Mrs. Debra Engelhardt-Nash SCDA Opening/Awards Luncheon - $35 Speaker: Dr. William R. Calnon, ADA President Clinical Management of TMD Speaker: Dr. Jeff Okeson Building a Strong Practice Speaker: Mrs. Debra Engelhardt-Nash Town Hall Meeting Welcome Reception with Exhibitors F01 5K Run/3K Walk - $15 (All proceeds donated to SCDA DAD project) Adult T-Shirt Size _________ F02 Past Presidents Breakfast (by invitation only) F03 Registration, SCDA Foundation Silent Auction & Exhibit Floor Open F04 CPR Recertification - $65 (space limited to 35 participants) Speaker: Mr. Calvin Wilson F05 Alliance Business Meeting F06 Predictable Outcomes in Full Arch Implant Supported Restorations Speaker: Joe Coursey F07 A Sound Recession Proof Restorative/Hygiene Practice; Integrating the Team and Creating the Value - Part I Speakers: Dr. Lou Graham and Ms. Renee’ Graham F08 Digital Dentistry, Modern Ceramics & Ceramic Bonding Speaker: Dr. Wally Renne F09 Autism and ADHD: How they Affect Dentistry Speaker: Dr. Roy Rockman F10 DenPac Board Meeting F11 Firearm Safety Class - $45 F12 MUSC, ACD, ICD, and PFA Luncheon - $35 F13 SCDLA Members Business Meeting / Luncheon F14 Golf Tournament at The Dunes Club - $85 (includes lunch) F15 3Shape CAD/CAM Speaker: Kathleen Catanzaro, CDT F16 CPR Certification - $65 (limited to 35 participants) Speaker: Mr. Calvin Wilson F17 Dental Trauma: What are Guidelines Worth? Speaker: Dr. Paul Eleazer F18 A Sound Recession Proof Restorative/Hygiene Practice; Integrating the Team and Creating the Value - Part II Speakers: Dr. Lou Graham and Ms. Renee’ Graham F19 SC Society of Pediatric Dentistry General Meeting F20 Ice Cream Break in the Exhibit Hall F21 Mastering Edentulous Impressions and Lab Communication Speaker: Dr. Joseph Thornton F22 MUSC/New Dentist & Pediatric Drop-In F23 South Carolina Academy of General Dentistry Drop-In F24 Palmetto Pavilion Tailgate Party - $20 10:00 a.m. - 12:00 p.m. 12:00 p.m. - 2:00 p.m. 1:00 p.m. - 4:00 p.m. 4:30 p.m. - 7:30 p.m. S01 DenPac Breakfast - $25 S02 Infection Control for the Dental Lab Team (Lab registrants only) Speaker: Dr. Charlie Hook S03 Update on the SC Healthy Connections Medicaid Dental Program & The Importance of Prenatal Dental Care in Birth Outcomes and “The Smiling Stork” Speakers: Dr. Doyle Williams & Ms. Rebekah Steen S04 Microbe Wars: Who Is Winning the Battle and Who Will Win the War? Speaker: Dr. Paul Eleazer S05 Infectious Control & OSHA Update for the Dental Office - $25 Speaker: Dr. Charlie Hook (All proceeds are donated by Dr. Hook to MUSC) S06 Hands-On E4D CAD/CAM Seminar (limited to 30 dentists) Speaker: Dr. Wally Renne S07 Clinical Success from A-Z, Adhesives to Zirconium Speaker: Dr. Rob Ritter S08 Complete Prosthetic Case Planning Speaker: Mr. Robert Kreyer, CDT S09 SCDAA Business Meeting S10 SCDLA Awards Luncheon ($35 for non-registered SCDLA attendees) S11 iCommunicate Speaker: Dr. Rob Ritter S12 Kentucky Derby Party at Thoroughbreds - $50 Sunday, May 6th 8:00 a.m. - 12:00 p.m. 8:30 a.m. - 9:00 a.m. S13 SCDLA CDT Exams S14 Sunday Morning Devotional Speaker: Dr. Larry Ferguson 8:00 a.m. - 10:00 a.m. 9:00 a.m. - 12:00 p.m. Registrant Name: _____________________________________________________________________________