How to Register
1. On-line www.scdaannualsession/ (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
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.
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:
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
Out-of-State ADA Member
ADA Non-Member Dentist
SCDLA Member, Military & Out-of-State CDT
SCDLA Non-Member
Dental Assistant
Business Assistant
Full-Time Faculty
Spouse of Dentist
MUSC Dental Student
Hygiene Student
Dental Assistant Student
SCDA or ADA Retired
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.
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
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
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
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.
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: _____________________________________________________________________________