MEETING REGISTRATION FORM
Hands-On Course Registration Form
Spring 2018 Meeting
(Limited to the first 25 registrants!!)
Presented by: Dr. Steve Wallace
Date: May 11, 2017
Time: 8am-9am – Registration & Breakfast
9am- 5pm – Hands-On Course
Topic: “Thinking Outside the Palate” – Simplified Recession Grafting
Place: PNC Bank Building
Two Tower Center Boulevard
East Brunswick, NJ
7 CE Credits
Registration Fee: $350 (NJSPID Member) $500 (Non-NJSPID Member)
Name: ______________________________________________________________________________ Office Phone: _______________________ E-mail:___________________________________________ Send registration and check payable to NJSPID or pay by credit card: Dr. Jane Ligums
P.O. Box 34 Gillette, NJ 07933 Cell: 908-581-4479 www.njperio.org