Northern Illinois Academy of General Dentistry

Presents:

Oral Pathology Update

Featuring:

Susan Muller, DDS, MS

Radisson Hotel & Convention Center
200 S. Bell School Road
Rockford, IL 61108
815-226-2100

Speaker Bio:

Course Information:

MORE INFORMAITON SOON

Course Objectives:

CE Credit:

7 hours of lecture credit may be used towards FAGD, MAGD or re-licensure for dentists and hygienists.

 When:

Friday, April  8, 2022
8:30—12:00 Lecture
12:00—12:30 Lunch
12:30—4:00 Lecture

 Price:

Return the completed form with your check payable to Northern Illinois Academy of General Dentistry to :
Stephen Petras, DMD, MAGD, FICOI
120 W. Front Avenue
Stockton, IL 61085
Phone: (815) 947-3700
Fax: (815) 947-9058
[email protected]

REGISTRATION FORM:    

• When Registering, please note if you require a vegetarian option for lunch!

                                                                                     AGD Member                                Non-AGD Member

Dentist or first person-                                                                $                                       $
From office:
First additional staff/Hygienist                                                     $

Each additional staff member                                                     $

Total Number Attending ___________________
Amount Enclosed _________________________

Total number of vegetarian lunches required_____
Signature ________________________________
Please Print:
Name: ______________________________________
AGD No. _______________________________
Name: ______________________________________
AGD No. _______________________________
Address: _____________________________
City, State, Zip: _______________________________
Office Phone: _________________________________
Fax No: _____________________________________
E-Mail Address: ______________________________

To pay with credit card contact Jamie Petras, NIAGD Executive Secretary at 815-541-3795 or [email protected]
Refund Policy: Full tuition refund is available without penalty up to one week prior to scheduled course.

For information contact:
Stephen Petras, DMD,MAGD, FICOI
Phone: (815) 947-3700
Fax: (815) 947-9058
E-mail: [email protected] OR [email protected]
________________________________________
ACKNOWLEDGEMENT
Presenting a program of this nature is a group effort, and would not be possible without the assistance of many individuals and companies. A complete listing of contributing companies will be available at the program site.