Registration Fees

                                                          Early (by 9/07/07)         Late (after 9/07/07)

                    Endodontist                                $695.00                            $795.00
                    Full Time Faculty                       $395.00                            $495.00
                    Military Endodontist                  $395.00                            $495.00 
                    Recent Endo Graduate              $395.00                            $495.00  
                     (Spring or Summer 2007)      
                    Full-time Resident                     $295.00                            $395.00


Please mail or fax the completed form with payment to:


M. Larmar Hicks, DDS, MS
University of Maryland School of Dentistry
Division of Endodontics
650 West Baltimore Street, Room 4217

Baltimore, Maryland 21201
Phone 410-706-7285

Fax:  410-706-3028

Endodontic Board Review and Scientific Update

Registration Form

  Name: _________________________________________________________________

  Address: _______________________________________________________________

 _______________________________________________________________________

  Phone: _____________________________     E-mail: ___________________________

  Type of Practice: ____________________ Present Position: ______________________

  Schools/Yrs Graduated/Degrees/Certificates: _________________________________

  _______________________________________________________________________

  Amount Enclosed $ ___________  Check  ___Visa  ___ AMEX  ___ MC  ___ Discover ___

  Checks Payable to “University of Maryland Baltimore”

  Card No.: ______________________________________________________________

  Exp. Date: __________________________  Signature: __________________________