SPDDS Midwinter 2017

Past Presidents' Breakfast (Invitation Only $12.00)*

No
Yes

How many Dentists ($75 each) are your registering?*

Dentist 1*

First Last

License Number of Dentist 1

Email of Dentist 1

CE Session 1 for Dentst 1 1 8:30 - 10:00*

Practice Dentistry Pain-Free: Evidence-based Strategies for a Long & Healthy Career 1.5 Elective CE’s
HIPAA, HITECH, ePHI: OMG, What a PIA 1.5 Fundamental CE’s
Minnesota Record Keeping Essentials 1.5 Core-Record Keeping CE’s

CE Session 2 for Dentist 1 - 10:30 to noon*

Fitness 101 for Dental Professionals: What Does the Research Say? 1.5 Elective CE’s
My Staff are Trying to Kill Me (And I Couldn’t Be Happier!) 1.5 Core-Patient Communication CE’s
Opioid Prescribing Protocols 1.5 Core-Diagnosis and Treatment Planning CE’s

Dentist 1 Lunch (included in registration)*

Lunch
No Lunch (-$10)

Dentist 2*

First Last

License Number of Dentist 2

Email of Dentist 2

CE Session 1 for Dentst 2 1 8:30 - 10:00*

Practice Dentistry Pain-Free: Evidence-based Strategies for a Long & Healthy Career 1.5 Elective CE’s
HIPAA, HITECH, ePHI: OMG, What a PIA 1.5 Fundamental CE’s
Minnesota Record Keeping Essentials 1.5 Core-Record Keeping CE’s

CE Session 2 for Dentist 2 - 10:30 to noon*

Fitness 101 for Dental Professionals: What Does the Research Say? 1.5 Elective CE’s
My Staff are Trying to Kill Me (And I Couldn’t Be Happier!) 1.5 Core-Patient Communication CE’s
Opioid Prescribing Protocols 1.5 Core-Diagnosis and Treatment Planning CE’s

Dentist 2 Lunch (included in registration)*

Lunch
No Lunch (-$10)

Dentist 3*

First Last

License Number of Dentist 3

Email of Dentist 3

CE Session 1 for Dentst 3 1 8:30 - 10:00*

Practice Dentistry Pain-Free: Evidence-based Strategies for a Long & Healthy Career 1.5 Elective CE’s
HIPAA, HITECH, ePHI: OMG, What a PIA 1.5 Fundamental CE’s
Minnesota Record Keeping Essentials 1.5 Core-Record Keeping CE’s

CE Session 2 for Dentist 3 - 10:30 to noon*

Fitness 101 for Dental Professionals: What Does the Research Say? 1.5 Elective CE’s
My Staff are Trying to Kill Me (And I Couldn’t Be Happier!) 1.5 Core-Patient Communication CE’s
Opioid Prescribing Protocols 1.5 Core-Diagnosis and Treatment Planning CE’s

Dentist 3 Lunch (included in registration)*

Lunch
No Lunch (-$10)

Dentist 4*

First Last

License Number of Dentist 4

Email of Dentist 4

CE Session 1 for Dentst 4 1 8:30 - 10:00*

Practice Dentistry Pain-Free: Evidence-based Strategies for a Long & Healthy Career 1.5 Elective CE’s
HIPAA, HITECH, ePHI: OMG, What a PIA 1.5 Fundamental CE’s
Minnesota Record Keeping Essentials 1.5 Core-Record Keeping CE’s

CE Session 2 for Dentist 4 - 10:30 to noon*

Fitness 101 for Dental Professionals: What Does the Research Say? 1.5 Elective CE’s
My Staff are Trying to Kill Me (And I Couldn’t Be Happier!) 1.5 Core-Patient Communication CE’s
Opioid Prescribing Protocols 1.5 Core-Diagnosis and Treatment Planning CE’s

Dentist 4 Lunch (included in registration)*

Lunch
No Lunch (-$10)

How many non-Dentists ($50 each) are your registering?*

non-Dentist 1*

First Last

License Number of non-Dentist 1

Email of non-Dentist 1

CE Session 1 for non-Dentist 1 1 8:30 - 10:00*

Practice Dentistry Pain-Free: Evidence-based Strategies for a Long & Healthy Career 1.5 Elective CE’s
HIPAA, HITECH, ePHI: OMG, What a PIA 1.5 Fundamental CE’s
Minnesota Record Keeping Essentials 1.5 Core-Record Keeping CE’s

CE Session 2 for non-Dentist 1 - 10:30 to noon*

Fitness 101 for Dental Professionals: What Does the Research Say? 1.5 Elective CE’s
My Staff are Trying to Kill Me (And I Couldn’t Be Happier!) 1.5 Core-Patient Communication CE’s
Opioid Prescribing Protocols 1.5 Core-Diagnosis and Treatment Planning CE’s

non-Dentist 1 Lunch (included in registration)*

Lunch
No Lunch (-$10)

non-Dentist 2*

First Last

License Number of non-Dentist 2

Email of non-Dentist 2

CE Session 1 for non-Dentist 2 1 8:30 - 10:00*

Practice Dentistry Pain-Free: Evidence-based Strategies for a Long & Healthy Career 1.5 Elective CE’s
HIPAA, HITECH, ePHI: OMG, What a PIA 1.5 Fundamental CE’s
Minnesota Record Keeping Essentials 1.5 Core-Record Keeping CE’s

CE Session 2 for non-Dentist 2 - 10:30 to noon*

Fitness 101 for Dental Professionals: What Does the Research Say? 1.5 Elective CE’s
My Staff are Trying to Kill Me (And I Couldn’t Be Happier!) 1.5 Core-Patient Communication CE’s
Opioid Prescribing Protocols 1.5 Core-Diagnosis and Treatment Planning CE’s

non-Dentist 2 Lunch (included in registration)*

Lunch
No Lunch (-$10)

non-Dentist 3*

First Last

License Number of non-Dentist 3

Email of non-Dentist 3

CE Session 1 for non-Dentist 3 1 8:30 - 10:00*

Practice Dentistry Pain-Free: Evidence-based Strategies for a Long & Healthy Career 1.5 Elective CE’s
HIPAA, HITECH, ePHI: OMG, What a PIA 1.5 Fundamental CE’s
Minnesota Record Keeping Essentials 1.5 Core-Record Keeping CE’s

CE Session 2 for non-Dentist 3 - 10:30 to noon*

Fitness 101 for Dental Professionals: What Does the Research Say? 1.5 Elective CE’s
My Staff are Trying to Kill Me (And I Couldn’t Be Happier!) 1.5 Core-Patient Communication CE’s
Opioid Prescribing Protocols 1.5 Core-Diagnosis and Treatment Planning CE’s

non-Dentist 3 Lunch (included in registration)*

Lunch
No Lunch (-$10)

non-Dentist 4*

First Last

License Number of non-Dentist 4

Email of non-Dentist 4

CE Session 1 for non-Dentist 4 1 8:30 - 10:00*

Practice Dentistry Pain-Free: Evidence-based Strategies for a Long & Healthy Career 1.5 Elective CE’s
HIPAA, HITECH, ePHI: OMG, What a PIA 1.5 Fundamental CE’s
Minnesota Record Keeping Essentials 1.5 Core-Record Keeping CE’s

CE Session 2 for non-Dentist 4 - 10:30 to noon*

Fitness 101 for Dental Professionals: What Does the Research Say? 1.5 Elective CE’s
My Staff are Trying to Kill Me (And I Couldn’t Be Happier!) 1.5 Core-Patient Communication CE’s
Opioid Prescribing Protocols 1.5 Core-Diagnosis and Treatment Planning CE’s

non-Dentist 4 Lunch (included in registration)*

Lunch
No Lunch (-$10)

Total

$0.00

Address for Credit Card*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email for Credit Card Receipt*

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Minnesota Dental Association

SPDDS Midwinter 2017

SPDDS Midwinter 2017

SPDDS Midwinter Attendee Registration