ࡱ> 574 ubjbjss 4u #)877777^)`)`)`)`)`)`)*-h`)QQQ`)77u)Q77^)Q^)'h(7И%yNg$(J))0)4(-}B- ((&-),dvt@`)`).)QQQQ- : ARK-LA-TEX ACADEMY OF DENTISTRY 806 Medical Circle #200 Longview, TX 75605 Registration (903) 753-0337 Fax (903) 236-4537 THE ARK-LA-TEX ACADEMY OF DENTISTRY PRESENTS REGISTRATION FORM FOR BREAD AND BUTTER ADHESIVE AND ESTHETIC DENTISTRY BY HAROLD HEYMANN FRIDAY, FEBRUARY 19, 2010 CLARION HOTEL SHREVEPORT, LOUISIANA PROMPT STARTING TIME 8:30 AM 7 HOURS CONTINUING EDUCATION LECTURE CREDIT REGISTRATION TO BE RECEIVED NO LATER THAN 5 DAYS PRIOR TO SEMINAR. TO REGISTER YOU MUST MAIL OR FAX THIS COMPLETED FORM TO: DR. CLINT BRUYERE, D.D.S. 806 MEDICAL CIRCLE #200 LONGVIEW, TX 75605 FAX (903) 236-4537 (Print Name)________________________________ [ ] I WILL ATTEND [ ] I WILL NOT ATTEND PHONE: ______________________________ THESE STAFF MEMBERS WILL ATTEND: ________________________________________ ________________________________________ ________________________________________ ________________________________________ 5. ________________________________________ Dr. Non-Member Fee: $245 (Non-refundable-$45 if not received by deadline) Enclosed is my check for Staff/Lab Tech (each): $35 (Non-refundable-$45 if not received by deadline) $____________. The Ark-La-Tex Academy of Dentistry is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of the program provider are accepted by AGD for Fellowship, Mastership, and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry. The current term of approval extends from October 19, 2003-October 18, 2006.  {      a b c o  tuƽƽƽƽ hV)h4hL5CJ\h:Q(5CJ\hD5CJ\hDhD5CJ\h45CJ\h4 h4CJh45CJ \  8Lh{    - C $ < O $a$gd:Q($a$O b c   @ A j k _ ugdV) & F$a$$a$gdL21h:pL/ =!"#$% ^ 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH >>  Heading 1$@& 5CJ\D@D  Heading 2$$@&a$ 5CJ\DA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List 2B@2 Body TextCJe LHTML Preformatted7 2( Px 4 #\'*.25@9CJOJQJ^JaJPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] uuO u 8@0(  B S  ?!"\|Vd"‡\5Çyć4Ň."Ƈ"LJD."ȇ."ɇ."ʇ/"ˇD/"̇t"͇"·"χ'!Ї!чc҇<8Ӈ9  88BF--9$$<<FI##.Rw     77@DKK7BB;;DHNN*??jw    9*urn:schemas-microsoft-com:office:smarttagsplace=*urn:schemas-microsoft-com:office:smarttags PlaceType=*urn:schemas-microsoft-com:office:smarttags PlaceName8*urn:schemas-microsoft-com:office:smarttagsdate;*urn:schemas-microsoft-com:office:smarttagsaddress:*urn:schemas-microsoft-com:office:smarttagsStreet8*urn:schemas-microsoft-com:office:smarttagsCity9*urn:schemas-microsoft-com:office:smarttagsState>*urn:schemas-microsoft-com:office:smarttags PostalCode "10192000DayMonthYearww{{ bcoyy iiB^kkmn~~tw wVi_f&<""&Bs"=B+Vl sydd^`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.^`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.^`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.^`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.^`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L."=B+f&""&Vi sy                                             D[H0"4D:Q(V)Luw@ux@UnknownG* Times New Roman5Symbol3. * Arial?= * Courier NewA BCambria Math"hB&B&WB&&9&9!r4OO2QHP?V)2!xx ARK-LA-TEXLinda01Jeff_Mutschler      Oh+'0   @ L X dpx ARK-LA-TEXLinda01 Normal.dotmJeff_Mutschler2Microsoft Office Word@ԭ@s@ޙgN@ޙgN՜.+,0 hp|  9&O  ARK-LA-TEX Title  !"#%&'()*+-./01236Root Entry F:6yN81Table .WordDocument4SummaryInformation($DocumentSummaryInformation8,CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q