SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF DENTAL MEDICINE
&
THE CENTRAL ILLINOIS ACADEMY OF GENERAL DENTISTRY
Presents:
MORE INFORMATION COMING SOON
At the completion of Day 1 of this course, the participant will have a clear understanding of:
Southern Illinois University School of Dental Medicine
Hoag Hall Auditorium, Bldg. 283
2800 College Avenue
Alton, IL
Directions: Take I-55 North or South to the Alton exit #30, Route 140. (Route 140 becomes College Avenue)
PARKING: Available behind Hoag Hall, Lots A-3. No permit is necessary. Do not park in the clinic parking lot. You will be ticketed.
Hotel Reservations based on availability. Identify
yourself as attending the Southern Illinois University
School of Dental Medicine AGD Programs.
Atrium Hotel (formerly the Holiday Inn)
3800 Homer Adams Parkway
Alton, Illinois
(618) 462-1220
Directions: Take 55 North or South to the Alton
Exit #30, Route 140. (140 becomes College Avenue)
Southern Illinois University School of Dental Medicine
FRIDAY, June 18, 2021
7:45 am Registration
8:00 am – 10:30 am Lecture in Hoag
Hall Auditorium (Bldg. 283)
10:30 am – 10:45 am Break and Discuss
12:00 pm – 1:00 pm Lunch and Learn with
the students
1:00 pm – 3:00 pm Lecture in Hoag Hall
Auditorium (Bldg. 283)
3:00 pm – 3:15 pm Break and Discuss
3:15 pm – 5:00 pm Lecture in Hoag Hall
Auditorium (Bldg. 283)
5:00 pm – 6:00 pm Set-up for Hands-on
7:30 pm – Dinner with seminar attendees &
instructor
DEADLINE:
Protocol Reporting Session
Protocol Reporting Session during Fellow Track student presentations at SIUSDM Thursday, June 17, 2021 at 7:30 PM at the Best Western Premier Hotel Restaurant Alton, IL Call 309-692-1796 or Email [email protected] for reservations.
SEMINAR COSTS AGD/ADA NON-AGD/ADA
PUBLIC HEALTH
Dentist 2 day participation
Dentist Lecture only
Staff (non-dentist) per day
(must be accompanied by dentist)
SIU Instructors/Students lecture N/C $10*
only and observation only.
Must be registered for seminar.
(Observation will be permitted at participation course (includes faculty/students) if course limit is reached, but costs and attendee numbers must be approved by the course master.)
Lunch is included in all day seminar cost.
*Includes 1 year AGD student membership
Non-Members: Join AGD and receive seminar at AGD member cost.
Contact Dr. Susan Bishop for information.
Refunds are available for courses, minus $50 processing fee, will be granted if requested at least ten days prior to the start of the course.
REGISTRATION FORM
Check appropriate line, or list number attending:
___AGD/ADA/Public Health Dentist $ _________
___Staff Member/AGD/ADA Dentist $ _________
___Non-AGD/ADA Dentist $ _________
___Staff Member/Non-AGD/ADA Dentist $ _________
___SIU/SDM Student/Resident $ _________
___SIU/SDM Faculty $ _________
TOTAL $ _________
AGD/ADA No. _________________________________________
Total Number Attending __________________________________
Amount Enclosed _______________________________________
Check Number _________________________________________
(Make check payable to the Central Illinois AGD)
Name: ________________________________________________
Address: ______________________________________________
City, State, Zip _________________________________________
Business Phone: ________________________________________
Home Phone: __________________________________________
Fax/E-mail Address: ____________________________________
___In Office Protocol
___Please send me a new AGD member packet.
If more than one person is attending, please list their names on a separate sheet of paper.
Return by
PAYMENT
Return the completed registration form and check payable to CIAGD to:
Dr. Susan Bishop
7314 N. Edgewild Dr.
Peoria, IL 61614
Email: [email protected] for information.
Next CIAGD/SIUSDM Seminar:
For more IL AGD CE Courses please go to ILAGD.org
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