CONTINUING DENTAL EDUCATION REGISTRATIONPrint form and once you have completed all fields sign the form. Please submit the form by mail, email or fax.UNLV School of Dental Medicine Address for MapQuest®/GPS driving directions:Continuing Education 1700 W. Charleston Blvd.1001 Shadow Lane, MS 7420 Las Vegas, NV 89106Las Vegas, NV 89106 (702)774-2822 • Fax (702)774-2820http://sdm.unlv.edu/ce (NEW website)

DDS/DMD AUX Date       Name (PLEASE PRINT)      

Address       City       State       Zip Code      

Phone       Fax       Email       License Number       (DDS/DMD)

Upcoming Courses:

Course Title CE Tuition Date(s)

Infection Control—E. Herschaft, DDS 4 $135 5/9/15

The Evolution of Endodontic Technique– Dr. Mario Abdennour 6 $149 5/16/15

Radiography/Haz Comm—Carole Brew 2 $55 ($45 for 2 or more) 5/20/15

Overdentures with Narrow-Diameter Implants – M. Scherer, DMD, MS/A. Ingel, DMD 16 $1595 6/5-6/15

Infection Control—E. Herschaft, DDS 4 $135 6/13/15

Dental Implants and Nerve Injury: The Danger Zone— M. Ragan, DMD, JD, LLM 3 $135 6/13/15

Cone Beam (CT) Radiography: A Certification Program for Dentists—J. Mah, DDS, MSc, DMSc/R. Danforth, DDS 16 $995 7/24-25/15

Cone Beam Computerized Tomography 2015— M. Scherer, DMD, MS/R. Danforth, DDS (CE PORTION OF DESTINATION CE @ NAPA VALLEY, CA)

6 $495 9/9-13/15

Real World Endo® Seminar - The Evolution of Endodontic Technique-- Dr. Keith Evans

6 $149 10/10/15

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Payment Information:

Check MasterCard Visa UNLV School of Dental Medicine Alumni? Yes No

Credit Card Number       Expiration       Security Code      

Total Amount      

Signature: *If paying by check, please make check payable to “Board of Regents”