Presents 2014 NORTHERN CALIFORNIA HIOSSEN ANNUAL MEETING Saturday, May 17th, 2014 8am to 6pm South San Francisco Conference Center 255 South Airport Blvd. South San Francisco 94080 Course Objective Hiossen Annual Meeting Registration Form This event will take place at the South San Francisco Conference Center on Saturday, May 17th. The event will be filled with renowned course directors lecturing on a variety of implant topics and techniques. Some of the topics discussed will include periodontal issues and oral surgery for general dentists, sinus lifting techniques, implant prosthetic restorations, and billing medical insurance for intra-oral procedures. The lecturers of this event are all prestigious practicing specialists and general dentists who lecture throughout the nation on dental implant topics. Hiossen is honored to have all these speakers together. Please come to the Hiossen Northern California Annual Meeting and advance your dental implant knowledge. Register by Mail or Fax Speakers Email: ________________________________________ Dr. Jon Suzuki "Management of Peri Implantitis" Dr. David Chong “Simple and Practical Approaches for Guided Bone Regeneration” Dr. Joseph Field "Full Mouth Implant Reconstruction -From Planning to Placement to Restoration." Name: _______________________________________ Customer Member #: ___________________________ Dental License #: _______________________________ Mailing Address: _______________________________ _____________________________________________ City Sales Representative Name: ______________________ MasterCard __ Visa __ Amex __ Discover __ Credit Card # __________________________________ Expiration Date:________________________________ Zip on Statement: ______________________________ CVN#: __________________ Amount: $ ____________ Authorized Signature ___________________________ “AIC-Hiossen, Inc. Advanced Dental Implant Research & Education Center (AIC) is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal Continuing Dental Education Programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by the state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 12/1/2012 to 11/30/2016. Provider #318822” Dr. Janice Wang “Negative Pressure Papilla Regeneration & Sinus Lift Techniques (using CAS & LAS Kit)” Dr. Rita Zamora "Social Media Marketing for Dentists topics.” Zip Phone: _______________________________________ Dr. Todd Wedeking “5 essential "Must dos" for every implant practice” Dr. Eugene Kim "Implant Assisted Overdentures". State Courses are applicable to ICOI Advanced Credentials 6 CE Credit Courses are applicable to ICOI and AGD advanced credentials Regular Cost: $300 AGD/ICOI Member & Early Bird Special: $250 Student Special: $100 *Price includes morning beverage, lunch buffet and refreshments. Contact: Hiossen SF Branch 700 Airport Blvd. #180 Burlingame, CA 94010 Tel: (650) 343-2280 Fax: (650) 343-2290 [email protected] Registration / Cancellation / CE Credits The number of registration is limited for each course, and registration is accepted on a first come, first serve basis. Full tuition payment must accompany all registration forms. Upon receipt of this registration form and tuitionfee, Hiossen will send you written confirmation. Confirming registrants who are unable to attend the course can obtain a refund by notifying Hiossen in writing no later than 14 days prior to the course date. Cancellations past that date will be subject to an additional penalty. Hiossen reserves the right to cancel a course no later than 14 days prior to the couse date. Please be aware that Hiossen is not responsible for reimbursement of a non-refundable airline ticket or any other travel expenses in the event that a course is canceled. Continuing education credits awarded in the United State for participation in the CE activity may not apply toward license renewal in all states, countries or provinces. It is the responsibility of each participant to verify the requirements of their state, country or province.