Register for the 2010 Seattle Study Club Symposium

Clinical Program Tuition

• On or before October 15, 2009 $2,395
• After October 15, 2009 $2,545

Personal Information

• Name:
• Select One: GP OS Perio Prosth Ortho Endo Lab Other
• Club Name:
• Address:
• City:
• State / Province:
• Zip:
• Home:
• Work:
• Cell:
• Fax:
• Email:
• Jacket Size: Male Small Medium Large X-Large XX-Large
    Female Small Medium Large X-Large
• Dietary Restrictions:
• Travel Arrangements: Staying at The Phoenician Resort
  Other, please specify

Monday Breakout Sessions

Please place in order of preference (1 who you would like to see the most, 6 is the least). Registrants will be assigned to two breakout sessions based on space availability.

• 1 2 3 4 5 6 Dr. Michael Fling
• 1 2 3 4 5 6 Dr. Bob Margeas
• 1 2 3 4 5 6 Dr. Harold Menchel
• 1 2 3 4 5 6 Dr. J. William Robbins
• 1 2 3 4 5 6 Dr. Jeffery S. Rouse
• 1 2 3 4 5 6 Dr. Marcos Vargas

Directors Only

Please choose from the following (Select One)

• Two breakouts selected above
• Drs. Avishai Sadan & Sillas Duarte

Tuesday Optional Clinical Photography Workshop

• Case Acceptance with Dr. Glen Krieger
  $595

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