2011 Oral Health Convention Registration Form
*Use One Form Per Registrant*
Section 1:
Please (
) one - D/ DH/ DA/OS Last Name _____________________
_ First Name ___________
___
Mailing Address:  Office  Home Street: _________________________________City: _______________________
Province: ____ PC : ___________ Telephone: Office: ___________________ Home:______________________
Email: __________________________________
Please specify if you will require  Special Assistance  Allergies: ___________________________________________
Section 2: Please indicate your attendance by placing an “X” in appropriate sessions incl. AGM’s, Reception and Socials.
Early Bird Registration ends Friday, April 29th; after this date a $25 administration fee will be applied.
Date
Time
8:30 am
Thursday
May 26
DH
DA/OS
$ 70
$ 40
Update on Acute Pain Management in Dentistry
(Dr. Choong Foong)
Is Your Office Ready for the Boomers: Dental
Care For An Aging Population (Dr. Mary
McNally)
$ 125
$ 70
$ 40
$ 125
$ 70
$ 40
1:00 pm
Overdentures And Treatment Planning with
Implants (Dr. Robert Vogel)
$ 125
$ 70
$ 40
8:30 am
NLDA AGM - Discussion & Interactive Session
$0
$0
$0
9:30 am
NLDHA Annual General Meeting
$0
$0
$0
10:30 am
NLDAA Annual General Meeting
$0
$0
$0
1:00 pm
NLDA AGM - Discussion & Interactive Session
Addictions and Oral Health Issues
(Cathy Wheeler-Walsh & Charlene Payne)
Update on Antimicrobials in Dentistry
(Dr. Shoong Foong)
Dealing with Difficult People
(Patricia Rose)
Update for the Dental Team on Medical
Emergencies
(Dr. Amin Alibhai)
A Financial check-up
(Debbie Okamoto – CDSPI &
Gino Ciavarella – Cumberland Private Wealth)
$0
$0
$0
$ 125
$ 70
$ 40
$ 125
$ 70
$ 40
$ 125
$ 70
$ 40
$ 125
$ 70
$ 40
$ 75
$ 35
$ 20
$ 75
$ 35
$ 20
8:30 am
1:00 pm
8:30 am
8:30 am
Saturday
May 28
D
$ 125
1:00 pm
Friday
May 27
Course Details
Basics To Implants For Everybody: How to
Grow your Practice with Implants
(Dr. Robert Vogel)
1:00 pm
1:00-2:30
3:00 – 4:30 Advancements in Treating Dentinal Sensitivity
(Tim Dixon - GSK)
pm
Totals
****You can register online at www.nlda.net****
Total
2011 Oral Health Convention Registration Form
H.S.T. must be added to each line entry for Social and Spousal Events (C.E. is HST Exempt!!)
Date
Thursday
May 26
Thursday
May 26
Friday
May 27
Saturday
May 28
Time
Social and Spousal Programs
7:30 am
Golf Tournament at Humber Valley Resort – Sponsored
by Dental Supplies & Dental & Hearing Crafts
6:00 pm
Reception Honoring Retired Members
7:30 pm
Broadway Pub Crawl
10:30 am –
3:30 pm
Bay Of Islands Tour & Luncheon
@ The Candlelite Bay Inn
NLDA Presidents Dinner
Indicate Number of Tickets: ______
(Dentist & Spouse No Charge)
NLDHA/NLDAA Social
Sir Wilfred Grenfell College Art Gallery & Luncheon
@ Bay of Islands Bistro
Fun Night!
Indicate Number of Tickets: ______
Dance Only!! Indicate number of Tickets______
7:00 pm
10:00 am –
2:00 pm
7:00 pm
Subtotal
Register
With
$0
HST
Total
Sponsors
_
$ 25
$ 3.25
$ 40
$ 5.20
$ 75
DH/DA/OS
$ 9.75
$0
$ 40
$ 5.20
$ 60
$ 20
$ 7.80
$ 2.60
TOTALS
Spouse’s Name____________________________________________________
Presidents Dinner- Friday, May 27
Cocktails: 6:30 pm
Dinner: 7:30 pm
Make your dinner choices below; (All dinners will be served with a Soup & Cheese Cake)
Savoury Stuffed Chicken _______
Crab Topped Salmon _______
Thai Turkey Tenderloin _______
Special Dietary Restrictions: ________________________________________________
Fun Night- Saturday, May 28
7:00 pm
The main course for Fun Night is Surf and Turf and Salads (1 Lobster & 1 6 oz. Steak/Person)
Special Dietary Restrictions: ________________________________________________
Payment Method
 MasterCard  VISA Credit Card #: ___________________________________ Expiry Date: __________
Cheque # _________
* Make Cheque Payable to: Nfld. & Labrador Dental Association
Grand Total_____________________________
Online & Office Registration closes Friday, May 13th, 2011
Onsite Registration begins Thursday, May 26th at 8:00 a.m.
Online Registration at www.nlda.net
Mail this form with payment to:
NLDA, Att: Oral Health Convention 2011
401-139 Water Street, St. John’s, NL A1C 1B2
Fax: (709) 579-1250 Email your registration form: Oralhealth@nfld.net