REGISTRATION FORM

REGISTRATION FORM
2008 Spring Meeting
MANAGEMENT OF IMPACTED TEETH IN THE DEVELOPING CHILD
An Oral Surgical, Orthodontic, Periodontal, and Pediatric Dental Perspective of the Standard of Care, Indications, Contraindications, Timing, Referrals and Outcomes


ISPD Member/District IV Member $95.00

ISPD Affiliate Member $95.00

Non-Member Dentist $195.00

Resident/Student $25.00

Staff Member $50.00

Last Name
First Name

Mailing Address
City
State
Zip

Business Phone Ext.
Fax Number
Email Address

Please return application with check made out to ISPD to the following address:
Ms. May Stern

Illinois Society of Pediatric Dentists
University of Illinois at Chicago
Department of Pediatric Dentistry (M/C 850)
College of Dentistry
801 S. Paulina Street
Chicago, IL 60612-7211
E-mail: maysie@uic.edu





Illinois Society of Pediatric Dentists
M/C 850
801 South Paulina Street
Chicago, IL 60612
312/413-7714