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Fluoride Varnish
Mini-Summit Registration

May 16, 2008 -- Kansas State Historical Museum, Topeka
10 a.m. - 2:30 p.m.

Registration for the Mini-Summit is now open. Register online today to reserve your spot!

There is no cost to attend, and lunch will be provided.

Click here for more information, including the full conference schedule.

Registrant information: (all items marked * are required). Note: you can use the tab key to move through the fields.

Registrant name
  
Prefix:
*First name:
Middle name/initial:
*Last name:
Suffix:
Your title:
*Org./Practice name
*Mailing address:
*City:
 , KS
*Zip:
*Phone:
Fax:
*Your email:

Please indicate your role (community leader, dentist, dental hygienist, dental assistant, early child care leader, insurer, nurse, nurse practitioner, office practice manager, oral health advocate, philanthropist, physician, physician's assistant, policymaker, other)
Role:

Please list any special needs (dietary, mobility, etc.):

Questions or comments?