Submitting an Invention to a Dental Manufacturer

Course and Enrollment Information

This is a one unit continuing dental education course given via the Internet. To view or take this continuing education course for credit or participate in the Question and Answer Forum, you will need to register for the course. To register for this course, "Submitting an Invention to a Dental Manufacturer":

1) fill out the following registration for the course

The following information is needed for registration purposes:

`Course Number and Title:` `Submitting an Invention to a Dental Manufacturer #2005`

`Name: ______________________________________________`

`Preferred prefix` `(Dr., Ms., Mr.): ________________________`

`Preferred suffix` `(DDS, RDH, CDA, PhD): ____________________`

`Business Address: ___________________________________`

(non dentists and dental__________________________

hygienists, please ________________________________

provide home address)____________________________

`E-mail: ____________________________________________`

`Day Phone: ________ Fax: `

`Dental School Attended: _____________________________`

`Year Graduated: ______ Specialty: _`

`Professional License #: _______ Social Security # _`

`Registration Fee:` `$25.00 (tuition in full)`

2) and enclose a check for $25 made out to The University of Michigan and send to:

Office of Continuing Dental Education

Room 1205 Dental School

University of Michigan

1011 North University

Ann Arbor, MI 48109-1078

Attn: Submitting an Invention to a Dental Manufacturer Internet Course

NOTE: If you register for 3 CDE Web courses at the same time, the registration fee is $60 instead of $75.

You will be sent a password to allow you to view the rest of the course and take the examination.

For those who would like a printout of the course and test, instead of a password required to complete the course via computer, follow steps 1 and 2 and request a printout.

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`Course Number and Title:` `Submitting an Invention to a Dental Manufacturer #2005`

`Name: ______________________________________________`

`Preferred prefix` `(Dr., Ms., Mr.): ________________________`

`Preferred suffix` `(DDS, RDH, CDA, PhD): ____________________`

`Business Address: ___________________________________`

`(non dentists and dental__________________________`

`hygienists, please` `________________________________`

`provide home address)____________________________`

`E-mail: ____________________________________________`

`Day Phone: ________ Fax: `

`Dental School Attended: _____________________________`

`Year Graduated: ______ Specialty: _`

`Professional License #: _______ Social Security # _`

`Registration Fee:` `$25.00 (tuition in full)`

Questions? Comments?

Questions or Comments relating to this CE course or activity can be:

sent electronically to Dr. Hamilton via DENTAL BBS (313) 761-9958 (8,N,1)

or e-mailed to Dr. Hamilton:

e-mail to: jchamilt@umich.edu

Course Number and Title: Submitting an Invention to a Dental Manufacturer #2005

Name: ______________________________________________

Preferred prefix (Dr., Ms., Mr.): ________________________

Preferred suffix (DDS, RDH, CDA, PhD): ____________________

Business Address: ___________________________________

(non dentists and dental __________________________

hygienists, please ________________________________

provide home address) ____________________________

E-mail: ____________________________________________

Day Phone: ______________________ Fax: ______________

Dental School Attended: _____________________________

Year Graduated: ________________ Specialty: ___________

Professional License #: _________ Social Security # ___

Registration Fee: $25.00 (tuition in full)

Questions? Comments?

Questions or Comments relating to this CE course or activity can be:

sent electronically to Dr. Hamilton via DENTAL BBS (313) 761-9958 (8,N,1)

or e-mailed to Dr. Hamilton:

e-mail to: jchamilt@umich.edu

`Course Number and Title:` `Submitting an Invention to a Dental Manufacturer #2005`

`Name: ______________________________________________`

`Preferred prefix` `(Dr., Ms., Mr.): ________________________`

`Preferred suffix` `(DDS, RDH, CDA, PhD): ____________________`

`Business Address: ___________________________________`

`(non dentists and dental__________________________`

`hygienists, please` `________________________________`

`provide home address)____________________________`

`E-mail: ____________________________________________`

`Day Phone: ________ Fax: `

`Dental School Attended: _____________________________`

`Year Graduated: ______ Specialty: _`

`Professional License #: _______ Social Security # _`

`Registration Fee:` `$25.00 (tuition in full)`