UIC College of Dentistry

University of Illinois at Chicago

Registration Form—
Fundamentals in Endodontic Microscopy

2008/2009 Course Schedule:
Indicate your 1st and 2nd choices by numbering the box, in order of preference, for dates of attendance. Whenever possible, you will be placed in your preferred dates.

2008/2009 dates are March 20 & 21, 2009!                

NOTE: Deadline for all courses is ONE month prior to course date!!)

Personal Information (Please print)

Name       

Address    

City                          St/Prov                      ZipCode                    Country    

Phone                        Fax                           E-Mail      

Fee Schedule: (Your Check payable to UIC must accompany your registration form.)

Dentists fee— (Assistant fee $900 per assistant if space available)

To pay IN ADVANCE         To pay IN INSTALLMENTS

$1,800 (enclosed) $500 deposit (enclosed)
                                 $1300 (payable before course date.) All fees are subject to change for unconfirmed registrations.

 

Tell us about yourself. Please check those items which best describe you.:
Alumnus                Endodontist         Dentist/Other                                                                      

Where did you hear about this course?
Journal Advertisement        Brochure               Recommendation from a colleague Department web site
Other                                                                                                                                                                                                     


Signature:                                                                                                                                             Date                                                      

Return this form, with your registration fee, to:

UIC College of Dentistry Department of Endodontics (M/C 642)
801 S. Paulina Street, chicago, Illinois 60612-7211
FAX: 312.996.3375

 

Thank you for your inquiry about

Fundamentals of Endodontic Microscopy

Ø To register

mail your check, with the enclosed application form, to

UIC College of Dentistry (M/C 642)
Department of Endodontics
801 S. Paulina, Chicago, IL 60612-7211

Be sure to print the form information, using the address and phone where we can best reach you during regular business hours. This course includes hands-on clinical practice in our state-of-the-art clinical settings. Enrollment is limited and early registration is recommended.

We’re sorry, but phone registrations cannot be confirmed.

To inquire about the availability of space in upcoming courses, please call—312/996-7514—between the hours of 9 am and 5 pm CST Monday through Friday.

Ø Your course fee

Includes the cost of your course handbook, lunch for each full program day, and refreshments in the morning and during breaks on most course days.

Fees for Fall, 2008 are:
Dentists $1,800/person
Dental Assistants (Limited space)    $900/person

You can register by enclosing your course fee or by paying a deposit of $500. If you preregister but cancel before the course date, your payment, less a cancellation fee, will be refunded.

Ø Course Credit

Participants will receive a certificate of attendance stating 14 hours lecture/participation credit. The University of Illinois at Chicago College of Dentistry is designated as a Recognized Provider by both the Continuing Education Recognition Program (CERP), conducted under the auspices of the American Dental Association, and the Association for Continuing Dental Education.

 

Ø Cancellations and Refunds

Cancellation and requests for refunds must be confirmed in writing, by mail or fax, before the date of your course. (See mail address, above, or fax to 312-996-3375.) Cancellation fees are $500 which is nonrefundable.

You may also reschedule and apply your fee to later course dates in the series. If you transfer your registration to other dates; fees will not be funded if you reschedule your registration to a later course date.

 

No refunds will be issued after the course date or for non-attendance.

Ø Accommodations

Many visitors prefer accommodations in downtown Chicago, and we recommend you register well in advance in your course date to avoid problems with the many conventions and events held in the city year-round.

If you prefer closer accommodations, The Marriott Chicago at the UIC Medical District is an excellent alternative. Just a short walk away from the UIC campus, located near the Ashland Avenue exit of the Eisenhower (I-290) Expressway and just minutes from downtown Chicago, the Marriott offers luxury rooms and fine dining.

To inquire about availability of accommodations at special UIC rates, phone the Marriott at 312/491-1234.

Ø Registration Questions?

Phone: 312/996-7514 (Office Hours 9:00 am-5:00 pm CST)
Fax: 312/996-3375
E-mail to: nancylee@uic.edu