Oral Health: "It's not just for dentists"

Primary Care Seminar & Interdisciplinary Clinical Skills Lab

Seminar manual, continental breakfast, lunch, credits, and breaks will be provided for the CME. No refunds; alternate attendee substitution allowed with prior notification. Preference will be given to those registered by March 9th, 2012. Full-time students, residents, and WVSOM Faculty & Staff may register at no cost. Onsite registrations may be accepted as space allows. For more information, please call 304.647.6358

The registration fee will be $50.00 if postmarked/received by March 9th, 2012. The fee will be $65.00 after March 9th or on-site.
If either of the options below apply to you, please select the appropriate checkbox:

• Regular Registration Fee ($50.00, $65.00 after March 9th, 2012)
• Registration Fee waived for WVSOM students
• Registration Fee waived for WVSOM Faculty and Staff

Please enter the following information:

First Name: Last Name: Medical Education Number: Mailing Address: Address (line 2): City StateSelect State Select StateAlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelewareFloridaGeorgiaGuamHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming Zip Daytime Phone Alternate Phone E-mail

Please check appropriate professions category below:

D.O.
M.D.
Ph.D.
Dentist
Physician's Assistant
FPN/RN/LPN
Resident/Intern
Student
Other: