craniofacial pain mini-residenc 2017-2018 · craniofacial pain mini-residency 2017-2018 program...

CRANIOFACIAL PAIN MINI-RESIDENCY

2017-2018PROGRAM CLASS 13

LECTURES, HANDS-ON WORKSHOPS, CASE REVIEWS, CASE PRESENTATIONS

SESSION 1 | SEP 7-9, 2017 Craniofacial Pain Disorders, History, Examination, Diagnosis, & Treatment Planning

SESSION 2 | NOV 9-11, 2017 Treatment & Management of the Patient with a Craniofacial Pain Disorder

SESSION 3 | FEB 8-10, 2018 Physical Medicine Modalities, Electro-Diagnostic Modalities, Intraoral Orthotics in the Management of the Craniofacial Pain Patient

SESSION 4 | APR 19-21, 2018 Orthodontics for Phase-II Finishing, Sleep Disorders, Phase-II Prosthodontic Case Finishing & Integration of Current Concepts in Craniofacial Pain in the Dental Practice

DOUBLETREE BY HILTON HOTEL | DALLAS-DFW AIRPORT NORTH | IRVING, TX

LEARN FROM THE EXPERTS AT AACP!

Gain the Knowledge and Clinical Skills Required

to Assess, Differentially Diagnose, and Effectively Treat

the Majority of Craniofacial Pain Patients seen in Dental

Practice Today. Simultaneously make

Progress Toward Fulfilling AACP Fellowship and

AGD Mastership Requirements

LIMITED ENROLLMENT | REGISTER NOW CALL 800.322.8651 or FAX 703.435.4390

Approximately 96 CE Credits (56 lecture, 40 participation) are Available in this 4-Session Craniofacial Pain Mini-Residency Program

2 REGISTER NOW CALL 800.322.8651 OR FAX 703.435.4390

AACP INSTITUTE | CRANIOFACIAL PAIN MINI-RESIDENCY PROGRAM CLASS 13

The greatest benefit that you will receive is the training to help a suffering patient population, many of whom have been experiencing pain for years and have thought their quest for relief to be hopeless. Many of these suffering people have seen a multitude of health-care providers, with no relief forthcoming.

In addition, the areas of craniofacial pain/temporomandibular disorders and sleep dentistry afford an excellent and lucrative income center to an existing practice, affording you access to a multitude of patients seeking relief for their problems.

If you are striving for exceptionalism as a practitioner, then this exceptional program is for you. Whether you simply wish to inte-grate these concepts into an already successful general dental practice or whether your desire is to ultimately focus your practice entirely to this discipline, this program will fulfill your needs.

I urge you to carefully evaluate this brochure, which outlines the programs and the curriculum. In addition, read the testimonials of past participants and visit the members section of the Academy web-site, www.aacfp.org, and click on “Institute” to see firsthand in both photographic and video format the content and tenor of this excel-lent program. If you are not a member of the academy, I urge you to become one. You will realize significant savings on your registration fee as well as receive exceptional benefits that membership provides. Contact our Executive Office at 800.322.8651 for details.

I am confident that you will find your continuing education invest-ment dollar well spent and know that the education that you will receive far exceeds the expenditure of time and money involved.

Terry R. Bennett, DMD AACP Past President

“The AACP Mini-Residency is structured to offer a great deal of didactic and practical learning material. It was instrumental in elevating both my understanding and

diagnostic skill, which my TMD patients are benefiting from now. In terms of both value and experience, it is truly one of the best courses available!” - Dr. Roger Cheung | BC, Canada

Dear Colleagues,I would like to invite you to join us as a partici-pant in the American Academy of Craniofacial Pain Institute Mini-Residency Program. This unique educational experience affords you the opportunity to participate in the finest pro-gram available dealing with craniofacial pain,

temporomandibular disorders, and sleep dentistry.

This exceptional four-part program combines pre-study-classroom lecture as well as hands and on participation to cover the area of craniofacial pain, temporomandibular disorders, and sleep dentistry in their entirety. The program is ideal for those doctors wishing to achieve fellowship in the American Academy of Craniofacial Pain. Fellowship in the Academy sets the doctor apart from the general dental population who treat craniofacial pain as part of a general dental practice or who limit their practice to this discipline.

Achieving fellowship in the Academy demonstrates that the doctor has completed exhaustive training, demonstrated extensive experi-ence, and has been thoroughly tested and evaluated by a testing body. This provides professionals in the health-care community, as well as patients, a means of selecting you as the professional they wish to refer to or seek care from. In addition, for those doctors who are on the Academy of General Dentistry mastership track, this pro-gram offers a combination of both lecture and participation that are required for the fulfillment of those requirements.

The program is designed for both the neophyte in this area who wishes to pursue exceptional educational experience to provide himself or herself with a broad base of knowledge and for the experienced practitioner helping himself or herself to categorize and systematize his or her approach to the treatment of patients.

“Wow! This program is by far the most complete and detailed approach toward a very complex (and often confusing) part of dentistry. Allowing time to pass between sessions gives the attendees a chance to study, learn, absorb, and apply much of what they are learning. The level of expertise the present-ers have is at once impressive and inspirational. The attitude of these presenters is one of the helpful mentoring, and no at-tendee could feel anything other than a truly open and encour-aging attitude from them.

In 40 years of dentistry, and participating in every CE program of national repute, without a doubt this mini-residency provided the most ‘bang for the buck.’ I would strongly encourage anyone practicing dentistry in the year 2010 to take up the challenge of becoming better informed, and more able to treat and help the myriad of patients suffering with TMD and the associated ills. I know everyone will be pleased (as I have been) to have made the decision to attend the program.” - Dr. Michael Folck | Virginia Beach, VA

http://www.aacfp.org

REGISTER NOW CALL 800.322.8651 OR FAX 703.435.4390 3


PROGRAM BENEFITS Enrollment is limited to ensure quality instruction, with priority registration given to dentists who register to attend the entire 4-session program.

Passing grades on all 4 exams offered with this program satisfy AACP Fellowship written exam requirements; case presentation and review prepares qualified candidates for the oral portion of the AACP Fellowship exam.

Curriculum and session content is evidence-based and 100% approved and endorsed by the American Academy of Craniofacial Pain, resulting in a superior learning experience.

Teaching/Learning Methodologies Lecture and participation is included in every session, with emphasis on clinically relevant knowledge and skills.Case review and case presentation experiences encourage development of a logical framework you can use to approach patients (and complete oral case defenses required for tier advancement in AACP and other organizations).

Stand-alone sessions enable you to enroll in the entire mini-residency program or attend individual sessions based on your schedule and personal interests.

End-of-Session Exams Fellowship in the AACP is available to AACP members only. Dentists wishing to test for Fellowship in the AACP will take four individual written examinations. The examination covering Session 1 will be given the evening prior to the start of Session 2, the Session 2 examination will be given the evening prior to the start of Session 3, the Session 3 exam will be given the evening prior to the start of Session 4, and Session 4 testing may be completed by mail utilizing a designated proctor prior to the AACP Summer Symposium or completed the day prior to the start of this summer meeting. Participation in the examination portion of the Craniofacial Pain Mini-Residency program is optional and at the discretion of each participant.

Continuing Education Credits Approximately 96 CE credits (56 lecture, 40 participation) are available to participants in this 4-session Craniofacial Pain Mini-Residency program.

DISTINGUISHED FACULTYTerry R. Bennett, DMD AACP Past PresidentDiplomate: American Board of Craniofacial Pain

American Board of Dental Sleep Medicine Academy of Pain Medicine

Fellow: American Academy of Craniofacial Pain

Cameron A. Kuehne, DMDDiplomate: American Board of Craniofacial Pain

American Board of Dental Sleep Medicine Fellow: American Academy of Craniofacial Pain

Edmund A. Lipskis, DDS, MSDiplomate: American Board of Craniofacial PainFellow: American Academy of Craniofacial Pain

International Association for Orthodontics American Association of Functional Orthodontics

Jeffrey S. McCarty, DDS AACP PresidentDiplomate: American Board of Craniofacial Pain

American Academy of Pain ManagementFellow: American Academy of Craniofacial Pain

Gerald J. Murphy, BS, DDSAACP Past PresidentDiplomate: American Board of Craniofacial Pain

American Academy of Pain ManagementFellow: American Academy of Craniofacial Pain

Wesley E. Shankland, II, DDS, MSAACP Past President Fellow: American Academy of Craniofacial Pain

H. Clifton Simmons III, DDSAACP Past PresidentDiplomate: American Board of Craniofacial Pain

American Board of Orofacial Pain American Academy of Pain Management

Fellow: American Academy of Craniofacial Pain

Robert L. Talley, DDSAACP Past PresidentDiplomate: American Board of Craniofacial Pain

American Board of Dental Sleep MedicineFellow: American Academy of Craniofacial Pain

Larry L. Tilley, DDSAACP Past PresidentDiplomate: American Board of Craniofacial Pain

American Board of Dental Sleep MedicineFellow: American Academy of Craniofacial Pain

AACP is an ADA CERP-Recognized Provider, January 1993 to December 2017.

ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by

boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to the Commission for Continuing Education Provider Recognition at ADA.org/CERP.

AGD Approved PACE Program Provider (#211843) FAGD/MAGD Credit June 1, 2011 to May 31, 2019

Continuing Education Recognition Program

“My experience with the mini-residency program offered by the AACP Institute went well beyond my expectations. Instead of receiving cookbook treatment modalities, I was presented with a philosophy of total patient care that will

positively affect my practice and my patients for the remain-der of my dental career. The instruction was top-notch and the hands-on aspect of the course was not matched by any other program I’ve seen.” - Dr. Rob Herron | Columbus, KS



Upon completion of Session 1, participants should be able to:

1. Recognize the most commonly occurring craniofacial pain disorders.

2. Complete a comprehensive history and examination of the craniofacial pain patient.

3. Understand the more commonly used diagnostic tests and when to implement them.

4. Make a provisional diagnosis based on patient complaints.

By the end of Session 1, participants should also have acquired, improved, and/or updated their knowledge of and ability to understand the clinical relevance of head-and-neck anatomy, recognize and diagnose dental-alveolar pains, and develop a treatment plan for the craniofacial pain patient.

22 APPROXIMATE CE CREDIT HOURS16 Lecture credits plus 6 participation credits

DAY 1:– Session and Course Overview

– Basic Head, Neck, & TMJ Anatomy as it Relates to Physical Examination

– Comprehensive History

– Examination – Physical Evaluation

– Muscle Identification & Palpation Workshop

– Question & Answer Session

DAY 2:– Plain Film & CT Imaging

– Joint Vibration Analysis (JVA)

– Magnetic Resonance Imaging (MRI)

– Temporomandibular Disorders

– Craniofacial & Neuropathic Pain Syndromes


DAY 3:– Range-of-Motion Evaluation, Cranial Nerve

Evaluation, & Otologic Evaluation Workshop

– Actual Patient History, Examination, & Consultation

– Treatment Planning

– Patient Consultation, Insurance Coding (CPT & ICD codes), Informed Consent, & Narrative Reports

– Case Planning for Session 2


SESS

ION

1 Craniofacial Pain Disorders, History, Examination, Diagnosis, & Treatment Planning

OBJE

CTIV

ES

“I am constantly going to courses and trying to do a better job. There were many cases that I just could not understand why my treatment was not working. This course brought it all together and gave me other tools to use—that work.” - Dr. Greg Sanchez | Albuquerque, NM

“As an orthodontist, this mini-residency gave me a thorough under-standing of the anatomy, physiology, and function of the masticatory complex and the many modalities available in treatment. It was one of the most intense and informative courses that I have ever completed.” - Ken Dillehay | Wichita, KS

SEPTEMBER 7-9, 2017




1. Treat and manage the myofacial pain-disorder patient.

2. Treat and manage patients with intra-articular pathology of the TMJ.

3. Treat and manage craniofacial pain syndromes. 4. Evaluate the necessity for pharmacologic

Management of the craniofacial pain patient.

By the end of Session 2, participants should also have acquired the ability to deliver trigger point injections, deliver intra-articular injections and manipulate the TMJ to reduce a non-reducing disc displacement. They should also understand what medications patients may present with and how these medications may adversely affect pain patterns; appreciate when, why and what medications to prescribe; appreciate the role of osteocavitation lesions in craniofacial pain disorders; understand trigeminal neuralgia and atypical facial pain.

DAY 1:– Welcome and Session Overview

– Case reports and Discussion

– Head and Neck Anatomy as it Related to TMD, Muscle Disorders, and Craniofacial Pain Disorders

– Anatomy Lab with Dissected Specimens

– Overview of Muscle Disorders

– Myofascial Pain Disorders: Introduction to Spray and Stretch

DAY 2:– Introduction to Trigger Point Injections

– Trigger Point Injection Workshop

– The NTI Appliance

– Pathology/Disease Process of TM Joints

– TM Joint Injection Techniques

– Non Reducing Disc Displacement Reduction Technique and Temporary Appliance Fabrication

– Common Craniofacial Pain Disorders

– Craniofacial Pain Disorder Diagnostic and Therapeutic Injections Workshop

– Factors Which Affect Pain Perception

DAY 3:– Pharmological Management of the Craniofacial

Pain Patient

– Temporary Splint Fabrication

– Undiagnosed Orofacial Pain Caused by Ischemic Bone Diseases

– Trigeminal Neuralgia: Typical, Atypical and Atypical Facial Pain

– Discussion of Case Presentation and Overview of Session 3

– Testing and Review

SESS

ION

2 Treatment and Management of the Patient with a Craniofacial Pain Disorder

OBJE

CTIV

ES


NOVEMBER 9-11, 2017




1. Prescribe the physical medicine modalities that best Complement and enhance the treatment objectives.

2. Apply electro-diagnostic instrumentation in the evaluation of the craniofacial pain patient.

3. Understand the different intraoral orthotics, (eg. types, designs, fabrications and management.)

4. Be able to fabricate the different orthotics in their office and be able to know which orthotics to use for each patient.

By the end of Session 3, participants should also have acquired, improved and /or updated their knowledge of and the ability to administer physical medicine modalities and understand which treatment is best for their patient. Participants should also be able to secure a rest position bite registration for orthotic fabrication and be able to fabricate in office the many different types of orthotics necessary for patient treatment. Each person should be able to organize and prepare a proper case presentation.

DAY 1:– Welcome and Session Overview

– Case Review and Discussion

– Electrotherapy & Electrophysics Concepts

– Application of High-Voltage and Transcutaneous Electrical Nerve Stimulation (TENS)

– Overview of Microcurrent, Inferential Stimulation and Laser Therapy

– Management of the Craniofacial Pain Patient

– Introduction to Neuromuscular Recording Devices

– Computerized Mandibular Scanning, Electromyography and Ultra-Low Frequency TENS

– TMJoint Vibratography and Sonography

– Neuromuscular Philosophy and Practice

DAY 2:– Muscle Disorders Encountered with TMD

– Appliances for Muscle Disorders

– Pain Release Splint

– PRS Demonstration and Fabrication Workshop

– Rest Position Appliance

– Taking a Rest Position Bite Relationship Workshop

– RPA Demonstration and Fabrication Workshop

DAY 3:– Disc Interference Disorders with TMD

– Orthotics for Disc Interference Disorders

– Anterior Deprogrammer Demonstration and Appliance Fabrication Workshop

– Demonstration/Workshop Appliance Fabrication, Both Direct and Indirect Methods of Fabrication

– Demonstration/Workshop Occlusal Registration

– Summing it up/Questions and Answers

SESS

ION

3 Physical Medicine Modalities, Electro-Diagnostic Modalities, Intraoral Orthotics in the Management of the Craniofacial Pain Patient

OBJE

CTIV

ES


FEBRUARY 8-10, 2018




1. Determine the best orthodontic approach for phase-II finishing.

2. Evaluate the craniofacial pain patient for obstructive Sleep apnea (OSA).

3. Determine if oral appliance therapy for OSA is indicated and, if so, the type of appliance to prescribe.

4. Create a predictable thought process to transi-tion a Phase 1 TMD patient to Phase II stability.

5. Determine the best prosthodontics finishing position and determine how to best restore the patient to that Position. Also the use of current materials and techniques to accomplish this.

6. Have the management skills to integrate craniofacial pain into the general dental practice.

By the end of Session 4, participants should also have acquired, improved, and/or updated their knowledge of and ability to use cephalometric analysis in orthodontic care of the extracapsular and intracapsular TMD patient plus orthodontic care to improve the airway, understand growth and development of the craniofacial complex, determine the timing for orthodontic treatment to correct craniofacial development problems, use diagnostic instrumentation for OSA, and appreciate what types of prosthodontics therapies might be best to restore the TMD patient to desired height and position to maintain the proper joint position and occlusion.

DAY 1:– Case Presentations

– Occlusion/Orthodontics/Malocclusion Philosophies

– Growth & Development of the Craniofacial Complex

– Orthodontic Diagnosis & Cephalometric Analysis

– Cephalometric Workshop

– Orthodontic Treatment Timing

– Orthodontics for the Extra-Capsular Patient

– Arc-Length Analysis Workshop

– Orthodontics for the Repositioned Patient

– Protocol if TMD Problems Return During/After

– Orthodontic Treatment

– Orthodontic Treatment to Help the Airway

DAY 2:– Introduction to the History of Sleep Medicine/Dentistry

– The Nature of Sleep

– Sleep Disorders

– Pediatric Development & OSA

– Obstructive Sleep Apnea

– Parasomnias

– Oral Appliance Fabrication Workshop

– Examination/Diagnosis

– Treatment Options

– Oral Sleep Appliances: Selection & Treatment Procedures

– Ambulatory Sleep-Study Workshop

– Problem Solving & Discussion

DAY 3:– Occlusion/prosthodontics/Malocclusion Philosophies

– Managing the Airway in Prosthodontic Rehabilitation

– Use of Orthotics to transition the Phase I patient to Phase II– Diagnosis and Treatment Planning Principles

– Intergration of Current Concepts in Craniofacial Pain into the Dental Practice

– Residency Wrap up, Group Discussion and Problem Solving

SESS

ION

4 Orthodontics for Phase-II Finishing, Sleep Disorders, Phase II Prosthodontic Case Finishing and Integration of Current Concepts in Craniofacial Pain in the Dental Practice.

OBJE

CTIV

ES

27.75 APPROXIMATE CE CREDIT HOURS15.5 Lecture credits plus 10.25 participation credits

APRIL 19-21, 2018



HURRY! Enrollment is limited and offered on a first-come, first-served basis.

HOW TO REGISTER Register online at www.aacfp.org or complete the registration form and submit via:

EMAIL [email protected]

FAX 703.435.4390

MAIL AACP 11130 Sunrise Valley Drive | Suite 350 Reston, Virginia 20191

Enrollment is limited —participants who register for the entire 4-session mini-residency will receive priority. Please do not make hotel and travel arrangements until you receive confirmation from the AACP Institute that your registration has been accepted.

REGISTRATION INFORMATION





Approximately 96 CE Credits (56 lecture, 40 participation) are Available in this 4-Session Craniofacial Pain Mini-Residency Program

TUITION

Entire 4-Session Program:

$10,740 (AACP-Member Doctors)

$13,600* (Non-Member Doctors)

Individual Sessions

$3,500 (AACP-Member Doctors)

$4,215* (Non-Member Doctors)

* JOIN AACP AND SAVE! To request a membership application, call the AACP Executive Office at: 800.322.8651

COURSE LOCATIONDoubleTree by HiltonDallas-DFW Airport North Irving, Texas

REGISTRATION DEADLINE Register early. Registrations will be accepted on a first-come, first-served basis. Payment of tuition in full is required to guarantee your space.

HOTEL ACCOMMODATIONS For reservations, call the DoubleTree by Hilton

972.929.8181

$194 (facility use & overnight guest room)

$95 (facility use only; no guest room)

“Multiple sessions, with time in between them, allows for learning in layers. This helped me to gradually incorporate into my practice what was being taught. There is so much more to treating TMD symptoms than just making a splint. This is a new growth center within my practice and is of great value to my patients. Time and money well spent!” - Dr. Kristin Morris | Cedar Rapids, IA


mailto:[email protected]



DoubleTree By Hilton Hotel Dallas-DFW Airport North

4441 W. John Carpenter Freeway | Irving, TX 75063 972.929.8181

HOTEL RATES:

Package Rate | $194 (with guest room— plus tax)

Per person/per day, including overnight accommodation; round trip shuttle transportation from DFW airport to the DoubleTree; and continental breakfast; all day break service; lunch and dinner; and unlimited use of the facilities. The above room rate is inclusive of guest service fees and service charges applicable to guest rooms and group functions. Lunch and dinner meals plus gratuities for bell staff and housekeeping are included.

Day Rate | $95 (without guest room— plus tax)

Per person/per day, including round trip shuttle transportation from DFW airport, continental breakfast; all day break service and lunch and dinner buffets, excluding overnight accommodations. The “Day rate” is applicable to participants who do not require overnight accommodations or who choose to stay at another hotel.

CHECK-IN, CHECK-OUT POLICIES: Guest accommodations will be available at 3:00 PM on arrival day and reserved until 11:00 AM on departure day. Any participant wishing special consideration for late checkout should inquire at the front desk on the day of departure.

GUEST-ROOM CHARGES: Participants will pay their own account upon departure. When reservations are made, a deposit equal to the package or room rate and tax for the night will be required. An individual’s deposit is refundable to the individual if the DoubleTree receives notice of an individual’s cancellation at least 24 hours prior to the scheduled arrival.

TRANSPORTATION: Take advantage of the complimentary 24 hour DFW airport shuttle. Once you have our luggage, call 972.929.8181 and the shuttle will be with you shortly.


2017-2018PROGRAM CLASS 13



LOCATION AND IMPORTANT DATESAll sessions in this limited-enrollment program will be held at the DoubleTree by Hilton at Dallas-DFW Airport North, Irving, Texas.





VISION:The American Academy of Craniofacial Pain will continue to be the organization promoting advancement of knowledge in Craniofacial Pain, Temporomandibular Disorders, and Dental Sleep Medicine by providing a common ground for clinical practice and research to professionals for the benefit of the public.

MISSION: The American Academy of Craniofacial Pain is committed to the relief of craniofacial pain, temporomandibular disorders and dental sleep related disorders and supporting the advancement of education, research and dissemination of knowledge and skills in these areas.

“Leading the TMD and Dental Sleep Community” is more than a slogan. It is our guiding rule! To ensure that our members are heard, since 1985 the AACP has been actively involved with:

Research organizations, such as the National Institutes of Health (NIH) and the National Institute of Dental & Craniofacial Research (NIDCR). Professional and political organizations, including the American Dental Association (ADA), state and local dental associations, licensing boards and the Food & Drug Administration (FDA). Ongoing clinical research that elevates professional standards of diagnostic testing, treatment protocols and outcome effectiveness.

REGISTRATIONRegister online at www.aacfp.org or complete the registration form and submit via:


FAX 703.435.4390

MAIL AACP 11130 Sunrise Valley Drive | Suite 350 Reston, Virginia 20191

HURRY! Enrollment is limited and offered on a first-come, first-served basis.

FORMS OF PAYMENT VISA, Mastercard and Check (in US funds, drawn on a US bank) NOTE: Tuition payment must be received by the AACP to reserve your space in this limited-enrollment mini-residency program!

JOIN AND SAVE Tuition savings is one of many benefits of being an AACP member. To qualify, simply submit a completed AACP membership application (with processing fee) with your Craniofacial Pain Mini-Residency program registration. To request your membership application, call AACP at 800.322.8651.

AMERICAN ACADEMY OF CRANIOFACIAL PAIN

Leading the TMD and Dental

Sleep Community

www.aacfp.org

CANCELLATION POLICY: Refunds will be made only if your space is filled. Refund requests (less 10% of TOTAL cost of the program) must be submitted in writing or email at least 30 days prior to the program start date. Due to non-refundable commitments, we cannot offer refunds after this date.

TUITIONPROGRAM MEMBER NON-MEMBER AMOUNT DUE WITH REGISTRATION

Entire 4-Session Mini-Residency

$10,740 $13,600 Save $1,000 with a 1 time tuition payment of:

– OR –

OR Make the first of 3 equal installments of:

$9,740 (AACP Members)$12,600 (Non-Members)

$3,580 (AACP Members)$4,533.33 (Non-Members)

Individual Sessions $3,500 $4,215 TUITION DUE IN FULL WITH REGISTRATION





NOTE:

LIMITED ENROLLMENT. REGISTER NOW! Participants who register for the entire 4-session mini-residency will receive priority.

PROGRAM MEMBER NON-MEMBER AMOUNT DUE WITH REGISTRATION

Entire 4-Session Mini-Residency

$10,740 $13,600 Save $1,000 with a 1 time tuition payment of:

– OR –

OR Make the first of 3 equal installments of:

$9,740 (AACP Members)$12,600 (Non-Members)

$3,580 (AACP Members)$4,533.33 (Non-Members)

Individual Sessions $3,500 $4,215 TUITION DUE IN FULL WITH REGISTRATION

*JOIN AACP AND SAVE! To request a membership application call 800.322.8651 or visit our website at www.aacfp.org

PART 1: REGISTRANT’S INFORMATION (PLEASE PRINT CLEARLY)

NAME

STREET ADDRESS

CITY STATE ZIP COUNTRY

PHONE FAX

E-MAIL

PART 2: REGISTRATION DETAILS

MEMBERSHIP STATUS (please check one)

SESSION CHOICES (please check all that apply)

TUITION AMOUNT (from chart above)

p AACP Member

p Non-Member

p Entire 4-Session Mini-Residencyp Session 1: September 7-9, 2017

p Session 3: February 8-10, 2018

p Session 4: April 19-21, 2018$ ___________________p Session 2: November 9-11, 2017

CANCELLATION POLICY Refunds will be made only if your space is filled. Refund requests (less 10% of TOTAL cost of the program) must be submitted in writing or email at least 30 days prior to the program start date. Due to non-refundable commitments, we cannot offer refunds after this date.

PLEASE initial at the left to confirm that you have read, understand, and agree to the AACP cancellation policy. Your regisitration will NOT be accepted WITHOUT this acknowlegdement.

PART 3: PAYMENT OPTIONSp Check Enclosed (in US dollars, drawn on a US bank) Payable to AACP in the Amount of $_________________

p Please Charge $_________________ to my: p VISA p MasterCard

BILLING ADDRESS (IF DIFFERENT FROM ABOVE) CITY STATE ZIP COUNTRY

CARDHOLDER NAME (EXACTLY AS IT APPEARS ON THE CARD) CARD NUMBER EXP DATE

CARDHOLDER’S SIGNATURE DATE

4 WAYS TO REGISTER 1. ONLINE: www.aacfp.org 2. EMAIL Completed the Registration Form to: [email protected] 3. FAX: 703.435.4390 4. MAIL: AACP, 11130 Sunrise Valley Drive, Suite 350, Reston, VA 20191

FULL payment is required to guarantee your space in this course. Since enrollment is limited, we recommend that you do NOT make your travel arrangements OR hotel reservations until you receive confirmation from the AACP Institute that your registration is confirmed. Instructions for providing occlusal models and bite registrations for each of your appliances will be furnished to you at that time.

CRANIOFACIAL PAIN MINI-RESIDENCY PROGRAM




REGISTER TODAY! ENROLLMENT IS LIMITEDParticipants who register for the entire 4-session mini-residency will receive priority. Please do NOT make hotel and travel arrangements until you receive confirmation from the AACP Institute that your registration has been accepted. There will be approximately 96 CE credits (56 lecture, 40 participation) available to participants in this 4-session Craniofacial Pain Mini-Residency program.

Course dates, locations, and registration information are available online at: www.aacfp.org or call the AACP Institute at 800.322.8651






“What can be said about any activities

that affirms our hopes for the future? The value of such fine

education is truly a bargain. I am excited

that I am experiencing this at my 30th year

of practice.” - Dr. Paul F. Mitsch | Augusta, KS

2017-2018 PROGRAM CLASS 13

AACP INSTITUTE

PROGRAM INFORMATION 308.384.5100

REGISTRATON INFORMATION 800.322.8651

TO REGISTER ONLINE GO TO:www.aacfp.org

OR COMPLETE REGISTRATION FORM AND SEND VIA:


FAX 703.435.4390

OR MAIL AACP 11130 Sunrise Valley Drive Suit 350 Reston, VA 20191




craniofacial pain mini-residenc 2017-2018 · craniofacial pain mini-residency 2017-2018 program...

Documents