Louisiana Dental Association



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Louisiana Dental Association


Continuing Education Course Form
To list your C.E. event on the LDA calendar, fill out this form completely and mail to Louisiana Dental Association, 7833 Office Park Blvd., Baton Rouge, LA 70809; fax to (225) 926-1886; or e-mail all information requested below to info@ladental.org. NOTE: the LDA gives first priority listings to LDA-sponsored events, followed by events sponsored by LDA components. The LDA reserves the right not to list events that directly conflict with LDA-sponsored events, events not sponsored by Louisiana-based organizations, and events not sponsored by ADA or AGD certified providers.
Course Title: (10 words or less)___________________________________

_______________________________________________________________________
course type: (lecture and/or participation) _____________________
designed for: (general dentist; specialist; hygienist; assistant; technician; all)_____________________________________________________
date/time: __________________________________________________________
credit hours: ______________________________________________________
Type: (Underline one) Clinical Practice Management
location: ___________________________________________________________
sponsor: (organization, address, phone #, Contact Person)______

_______________________________________________________________________


instructor: ________________________________________________________
fee: (mbr; non-mbr; staff; std) _____________________________________
Sponsoring organization is approved by: (put an x by one)

_____ ADA-CERP _____ AGD-PACE ______ N/A
subject area: (circle one)

Anesthesia/Pain Control

Basic Science

Dental Materials

Endodontics

Esthetic Dentistry

General Dentistry

Implants

Infection Control

Occlusion/TMD

Operative Dentistry

Oral Diagnosis/Dental Radiology

Oral Medicine/Therapeutics

Oral Pathology

Oral Surgery

Orthodontics

Pediatric Dentistry

Periodontics

Practice Administration

Preventive Dentistry

Prosthodontics

Public Health Dentistry

Restorative Dentistry

Special Patient Care

Course for Auxiliaries





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