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