ABOUT THE SPEAKERS INFORMATION INFORMATION CONTINUED

Annual Prosthodontics, Dental Implants, Digital Dentistry, Dental Sleep Medicine and Oral and Maxillofacial Surgery for General Practitioners

Monday, July 22 – Saturday, July 27, 2019 • Registration Deadline: Monday, July, 15, 2019 **Please make additional copies for each person registering

Email ______________________________________@ ______________________________All registrants must provide a unique e-mail address (robert.jones@gmail.com) in order to access credit history and be entered into our database. Generic office email addresses that are shared by many individuals ( finance@dentistoffice.com) cannot be used.

First Name _________________________ Last Name ____________________________ Jr. / Sr.

Preferred Name _______________________________________________________________

Male Female Self-identify __

I am an alumnus/alumna of UNC School of Dentistry: DDS RDH DA Post Doc Employer

___________________________________________________________________ Mailing

Address _______________________________________________________________ City

_______________________________________ State _________ Zip ________________ County

in NC _________________________________________________________________ Daytime

Phone (_____) _________________________ Fax (______) ______________________

Register On-line with a Credit Card at www.dentistry.unc.edu/ce/cde

DDS: $1095 Daily Fee: $350 Team Member: $525 Daily Fee: $225

If you have any questions, call (919) 537-3400 or email us at cde@dentistry.unc.edu NOTE: Please select the days you will be attending

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

$350 Dentist OR $225 Team Member

$350 Dentist OR $225 Team Member

$350 Dentist OR $225 Team Member

$350 Dentist OR $225 Team Member

$350 Dentist OR $225 Team Member

$350 Dentist OR $225 Team Member

_____________$

_____________$

_____________$

_____________$

_____________$

_____________$

_____________$TOTAL ENCLOSED

I have special dietary needs (please explain) ___________________________ I have special needs, please contact me _________________________________

ADA STATEMENT: The University of North Carolina at Chapel Hill is committed to equality of educational opportunity and does not discriminate against applicants, students, or employees on the basis of race, color, religion, sex, national origin, age, disability, veteran’s status, or sexual orientation. If you require reasonable accommodations for a disability in order to participate fully in this continuing education Course, please call 919-537-3400 no later than Wednesday, June 5, 2019 or attach a note to your registration form.Dental education institutions have an obligation to disseminate new knowledge related to dental practice. In so doing, some presentations may include

controversial materials or commercial references. Sponsorship of a continuing education course by the University of North Carolina does not necessarily imply endorsement of a particular philosophy, procedure, or product by this institution.The University of North Carolina School of Dentistry cautions continuing dental education participants that there are potential risks of using limited

knowledge when incorporating new techniques and procedures into the practice of dentistry, especially when the continuing education course has not provided supervised clinical experience and/or competency tests in the techniques or procedures.By providing my information, I consent to receive communications via mail, email, fax, and phone from the University of North Carolina Continuing

Dental Education office. The Continuing Dental Education office will not share your information with anyone.

continuing education course has not pro-vided supervised clinical experience and/or competency tests in the techniques orprocedures.

By providing my information, I consent to receive communications via mail, email, fax, and phone from the University of North Carolina Continuing Dental Education office. The Continuing Dental Educa-tion office will not share your information with anyone.

Dr. Ariel J. Raigrodski is a Professor at the Department of Restorative Dentistry and an Adjunct Professor at the Department of Materials Science and Engineering at the University of Washington. He also maintains a private practice limited to

Restorative, Implants and Esthetic Dentistry in Lynnwood, WA. He is Assistant Editor of The Journal of Prosthetic Dentistry and a member of the editorial review boards of the Journal of Esthetic and Restorative Dentistry, the Journal of Prosthodontics, and the International Journal of Periodontics and Restorative Dentistry. Dr. Raigrodski is a graduate of the Hebrew University in Jerusalem Israel. He received his certificate in Prosthodontics at Louisiana State University School of Dentistry, where he also completed a fellowship in implants and esthetics, and an MS degree. He is a Diplomate of the American Board of Prosthodontics, a Fellow of the American College of Prosthodontists, a Fellow of the International College of Dentists, and a member of many professional organizations. An author of numerous scientific articles and book chapters, Dr. Raigrodski’s research is mainly clinical and focuses in all-ceramics, implants, and CAD/CAM technology. He is the Author of “Soft Tissue Management: The Restorative Perspective-Putting Concepts into Practice” published in 2015 by Quintessence Publishing. He lectures extensively both nationally and internationally.

Dr. Ibrahim Duqum is a Clinical Assistant Professor at the Department of Prosthodontics and the Director of the New Education Experience and Technology Place (NEXT) at the University of North Carolina School of Dentistry.

Dr. Tate H. Jackson is an Assistant Professor at the University Of North Carolina Department Of Orthodontics. He was born in Nashville, Tennessee and graduated first in his class with honors from the University of North Carolina School of

Dentistry. Following dental school, Dr. Jackson earned an MS degree as a part of his specialty training in Orthodontics at UNC. He also completed the Proffit Teaching Fellowship as well as the NextGen Fellowship in clinical and translational research. After practicing Orthodontics full-time in Manhattan,

Dr. Jackson joined the faculty at UNC as an Assistant Professor in June of 2015. Dr. Jackson is a Diplomate of the American Board of Orthodontics.

Dr.Taiseer Sulaiman is an assistant professor in the Department of Operative Dentistry in the UNC SOD. He received a clinical certificate from the UNC Department of Operative Dentistry and his PhD from the Department of Prosthetic and Biomaterials Science, University of Turku, Finland in collaboration with the

UNC Department of Operative Dentistry. His research focuses on integrated and applied material sciences in areas of dental ceramics, color in dentistry, dental cements and composite resins. He is an active member of numerous clinical and research academies, and a speaker/lecturer nationally and internationally.

Dr. Robert Wright is a professor and chair of the department of Prosthodontics

Questions? Call us at 919-537-3400 or email us at cde@dentistry.unc.edu

REGISTRATION AND FEESThe UNC School of Dentistry designates this activity for up

to 24 hours of continuing education credits for attending the complete 6 day program. Up to 4 hours of continuing education credit per day, subject to regulation by individual state boards. This course will be held dailyfrom 8:00 am to 12:30 pm. Your registration fee includes a buffet breakfast each morning, course materials and CE credit.

UNC CDE recommends that you do not make air travel arrangements prior to receiving a receipt of payment or confirmation. UNC CDE is not responsible for any travel-related costs.

The complete 6-day course registration fees are $1050 for Dentists and $550 for Team Members. You may attend on a daily basis for a fee of $300/day for Dentists and $200/day for Team Members.

CANCELLATION POLICYA registration refund, less a $75 fee, will be issued for cancellations received in writing by

Friday, July 15, 2016. Cancellation requests must be received in writing either via fax 919-537-3098 or email cde@dentistry.unc.edu. The cancellation request must include: the name of the activity, name of the person registered, name of the person requesting the cancellation, and the reason forthe cancellation. No refunds will be issued after Friday, July 15, 2016. The UNC School of Dentistry Continuing Dental Education Program cannot be responsible for the refund of any part of the registration fee as a result of emergencies, unforeseen circumstances, or events beyond its control afterthe cancellation date.

The University reserves the right to cancel or post-pone any course due to unforeseen circumstances. In the event of cancellation or postponement, the University will fully refund registration fees but is not responsible for any related costs or expenses to participants, including cancellation fees assessed by hotels, airlines, rental car or travel agencies.

Special dietary requirements will be honored whenever possible. Please be sure to notify our office inwriting of your special need no later than Friday, July 15, 2016.

ACKNOWLEDGEMENTUNC School of Dentistry would like to acknowledge GC America for supporting this activity with an

unrestricted educational grant.

The UNC School of Dentistry is an ADA CERP Recognized Provider.

This continuing education program is presented by the University of North Carolina at Chapel Hill School of Dentistry and the Department of Prosthodontics. The UNC Continuing Dental

Education program is an ADA CERP Recognized Provider. UNC CDE’s term of recognition is May 1, 2015 through June 30, 2019. ADACERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours byboards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at www.ada.org/cerp.

REGISTRATION

35thCourse Code (20 PR 001)

at the University Of North Carolina School Of Dentistry. He is a Diplomate of the American Board of Prosthodontics and a Fellow of the American College of Prosthodontists.

“This course is by far the best bang for the buck. I have been coming for about 20 yearsand each year the course is exciting and applicable.” - Robert Bartusiak, McMurray, PA

“I’ve come every year for at least 10 years and will continue to come. You do a great job.Keep it up. Thanks.” - John Erbaugh, Dayton, OH

“Super program this year! Great topics, very up-to-date.” - John Backof, New Holland, PA

“Thank you for a special course. My batteries are recharged and I’m ready to hit theground running.” - John Rhodes Jr., Brookville, OH

ACCOMMODATIONSThe course will be held at The Westin Hilton Head Island Resort & Spa located on Hilton Head Island, SC. Once you have registered for the course call: 843-681-4000 to make your room reservation. When making reservations mention the UNC School of Dentistry room block for the best room rates.

Hurry! Room block typically sells out early and the room block expires on Sunday, July 3, 2016. Rates are $259 per night for single or double occupancy standard rooms.

For more information on The Westin Hilton Head Island Resort & Spa and to make room reservations visit our course page at: https://www.starwoodmeeting.com/Book/UOG21B and click on the link provided.

REGISTER BY MAILSend completed registration form with a check or money order made payable to:UNC School of Dentistry to:

Attention: RegistrationContinuing Dental EducationCampus Box 7450Chapel Hill, NC 27599-7450

Register on-line (only for the full 6 day conference)Direct your web-browser to www.dentistry.unc.edu/ce/cde