Cosmetic Dentistry Brochure

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					REGISTRATION
                                            Dr. James E. & Joan B. Overberger Endowed Lecture Series
                                                  “Cosmetic Dentistry: The Pursuit of Excellence”

                                 November 7, 2008 • Waterfront Place Hotel, Two Waterfront Place, Morgantown, WV
    Course Registration is requested by October 29, 2008. Pleast print or type. (You may photocopy this form for additional registrants)

Name:____________________________________________________________________________________________

Primary State of Licensure:___________________________________________Date of Birth:_____________________

Professional License Number:_________________________________________________________________________

Mailing Address:____________________________________________________________________________________

City:__________________________________State:____________Zip:_____________County:____________________

Office Telephone:_____________________Home Telephone:____________________Fax Number:_________________

Email:_______________________________Specialty:___________________Subspecialty:_______________________

Course Fees                                                                                                                                        Before Oct 29       After Oct 29
Non WVU School of Dentistry Alumni Association Members                                                                                             $325                $350
WVU School of Dentistry Alumni Association Members                                                                                                 $295                $325
WVU Faculty/Hygienists/School of Dentistry Alumni Member Dental Auxiliaries                                                                        $150                $180
Hygienists/Dental Auxiliaries of Non WVU School of Dentistry Alumni Association Members                                                            $175                $200


                                                                                                                      TOTAL ENCLOSED:________________________
              Check made payable to: West Virginia University
              Visa   Mastercard      Diner’s Club    Discover                                            American Express

Cardholder Name:____________________________________________________________________________________________
Cardholder Full Billing Address:_________________________________________________________________________________
                                                                                                                                                                                                 MORGANTOWN, WV 26506-99080




Card Number:________________________________________________________________________________________________
                                                                                                                                                                                                 5302 HEALTH SCIENCES SOUTH




Expiration Date:__________________________CVV Code*:_________________
                                                                                                                                                                                                 ADDRESS SERVICE REQUESTED




Signature:___________________________________________________________________________________________________
*The CVV code appears as three or four digit number printed on the reverse of the card of the signature panel following the account number.
                                                                                                                                                                                                 SCHOOL OF DENTISTRY

                                                                                                                                                                                                 P.O. BOX 9080 - DW




              Please check here if you do NOT want your name on the participant listing.

Mail this registration form & payment to:                                                                            If you have special needs (dietary, access, parking) please describe:
West Virginia University School of Dentistry                                                                         ________________________________________________________
c/o Office of Student Affairs                                                                                         ________________________________________________________
1037 Health Sciences North                                                                                           ________________________________________________________
P.O. Box 9404 - DW                                                                                                   ________________________________________________________
                                                                                                                                                                                             ®




Morgantown, WV 26506-9404                                                                                            ________________________________________________________
Or fax to: (304) 293-2859                                                                                            ________________________________________________________
                              ®
                                                                         SCHOOL OF DENTISTRY                                     Program                                                                                                                                                              Office of Continuing Education
                                  SCHOOL OF DENTISTRY                    ALUMNI ASSOCIATION                                                                                                                                                                                                                  www.ce.wvu.edu
                                                                                                                                 Friday, November 7, 2008
                      Dr. James E. & Joan B. Overberger Endowed Lecture                                                                                                                                                                            Registration                                                                               Cancellations
                                                                                                                                 7:00 am Registration, Continental Breakfast, and Exhibit Visitation                                                  To join us for the Cosmetic Dentistry: The Pursuit of                                       Important: If you are unable to attend the course after
       Cosmetic Dentistry: The Pursuit of Excellence                                                                             8:00 am CE Course Part 1                                                                                          Excellence course, please complete the attached registration
                                                                                                                                                                                                                                                   form and return it by October 29, 2008, to the WVU School
                                                                                                                                                                                                                                                                                                                                              you have registered, you must notify us in writing by
                                                                                                                                                                                                                                                                                                                                              October 29, 2008, to receive a refund. No refunds for
                                                                                                                                 12:00 pm Lunch and Exhibit Visitation                                                                             of Dentistry along with your payment (checks made payable                                  course fees will be made after October 29, 2008. A $50
                                                                                                                                                                                                                                                   to West Virginia University, MasterCard, VISA, Discover,                                   fee will be charged for all cancelled registrations.
    This course will illustrate the many ways that your             Dennis J. Wells, DDS, founder of the Nashville               1:30 pm CE Course Part 2                                                                                          American Express or Diner’s Club). Registrations received by                                   We reserve the right to cancel individual sessions or
dental practice will be affected when you follow path           Center for Aesthetic Dentistry, is a graduate of
guided by your pursuit of excellence. By developing a
                                                                                                                                 5:00 pm Adjourn                                                                                                   October 29, 2008, will be confirmed in writing.                                             the entire course. In the event of a cancellation, a full
                                                                Harding University and the University of Tennessee                                                                                                                                                                                                                            tuition refund will be made.
keen appreciation for natural beauty and learning ways to       Dental School. He received his accreditation with the
conservatively enhance your patients’ smiles, your artistic
                                                                                                                                                                                                                                                   Course Credit
                                                                American Academy of Cosmetic Dentistry (AACD)                    Course Benefits Include                                                                                                                                                                                       Location
                                                                                                                                                                                                                                                       This program is approved for 7 CE credit hours.
skills will grow along with your enjoyment of dentistry.        in 1994, and has since served as an examiner for                 This presentation will illustrate how the pursuit of excellence influences these areas of cosmetic dentistry in:
                                                                                                                                                                                                                                                                                                                                              The Waterfront Place Hotel is located at Two Waterfront
Combining fine-tuned communication skills with your              the AACD accreditation process. He is founding                   • Minimal-prep and no-prep dentistry
                                                                                                                                                                                                                                                                                                                                              Place, Morgantown, WV. Reservations can be made by
clinical abilities will result in a mutually beneficial          president of the Tennessee Chapter of the AACD, and              • Emulating natural beauty
                                                                                                                                                                                                                                                                                                                                              calling 304-296-1700.
partnership, where even the most discerning clients will be     has been an instructor for the “P.A.C.-live” aesthetic
satisfied.                                                       continuum in San Francisco, a premier post-graduate              Educational Objectives
                                                                                                                                                                                                                                                      The WVU School of Dentistry is an ADA CERP                                              Parking
                                                                program sponsored by the University of the Pacific                At the conclusion of this course participants should be able to:
                                                                                                                                                                                                                                                   Recognized Provider, an approved Academy of General                                           Paid parking is available on-site.
                                                                Dental School. Dr. Wells was honored to be included              • Understand artistic perspectives in dentistry
                                                                                                                                                                                                                                                   Dentistry (AGD) Program Approval for Continuing Education
                                                                in Who’s Who in Dentistry and is a Fellow of the                 • Learn to satisfy the most discerning client
                                                                                                                                                                                                                                                   ( PACE) Program Provider (FAGD/MAGD Approved                                               Special Thanks
                                                                International Academy for Dento-Facial Esthetics.                • Refine communication skills
                                                                                                                                                                                                                                                   11/1/05-12/31/09), and an Association for Continuing Dental                                    Special thanks to the Exhibitors for their Support of
                                                                                                                                 • Create a nice cosmetic practice
                                                                                                                                                                                                                                                   Education (ACDE) Approved Provider.                                                        this course.
                                                                   Dr. Wells lectures internationally on cosmetic
                                                                                                                                                                                                                                                      The School of Dentistry has an obligation to disseminate
                                                                dentistry, and practices in Nashville, Tennessee where
                                                                                                                                                                                                                                                   new knowledge related to dental practice. In doing so,                                     Additional Information
                                                                he has designed the smiles of many celebrities in the
                                                                                                                                                                                                                                                   some presentations may include controversial material or                                       For more information on this and other upcoming CE
                                                                music industry. He is a member of the Matrix Band
                                                                                                                                                                                                                                                   commercial references. Sponsorship of a dental continuing                                  conferences, contact the Office of CE at (304) 293-3937,
                                                                and coordinated the Matrix band CD project for the
                                                                                                                                                                                                                                                   education course by the School of Dentistry does not                                       visit our web site at www.ce.wvu.edu or e-mail us at
                                                                Give Back a Smile Foundation benefiting victims
                                                                                                                                                                                                                                                   necessarily imply endorsement of a particular philosophy,                                  ce@wvu.edu.
                                                                of domestic violence. Dr. Wells appeared in an
                                                                                                                                                                                                                                                   procedure or product by this institution. Continuing Education
                                                                episode of The Learning Channel series “A Personal
                                                                                                                                                                                                                                                   courses do not necessarily reflect the philosophies of the
                                                                Story” which focused on the smile enhancement of a
                                                                                                                                                                                                                                                   School of Dentistry pre-doctoral or post-doctoral education
                                                                Nashville area patient. He has also provided cosmetic
                                                                                                                                                                                                                                                   programs.
                                                                dentistry for several episodes of ABC’s hit series,
                                                                                                                                                                                                                                                      Participants are cautioned about the potential risks of using
                                                                Extreme Makeover.
                                                                                                                                                                                                                                                   limited knowledge when incorporating new techniques and
                                                                                                                                                                                                                                                   procedures into their practices.
Disclosure Statement
   It is the policy of the WVU Health Sciences Office of Continuing Education to ensure balance, independence,
objectivity, and scientific rigor in all its educational activities. All faculty/authors/planners participating in our programs
are expected to disclose any relevant relationships they may have with commercial companies. For this conference Dr.                                                                                                                               West Virginia University is an Equal Opportunity/Affirmative Action Institution.
Wells has indicated he has a small proprietary interest in DURAthin veneers as the co-developer with Mark Willes at                                                                                                                                The University does not discriminate on the basis of race, sex, age, disability,
Experience Dental Studio.                                                                                                                                                                                                                          veteran status, religion, sexual orientation, color or national origin. Inquiries may be
                                                                                                                                                                                                                                                   directed to the Executive Officer for Social Justice, 105 Stewart Hall, Office of the
                                                                                                                                                                                                                                                   President, (304) 293-5496