American Society of Master Dental Prosthologists, Inc.
146-21  13th  Avenue
 Whitestone, NY  11357
(718) 746-8355
 

 Application Form for the home study MASTER COURSE
of Dentistry for Continuing Education Courses  ASMDT Program.

CHAIRMAN

Vincent V. Alleluia, M.D.T., T.F.

PRESIDENT ELECT

Paul Federico, M.D.T.

VICE PRESIDENT

Paul Eliason, MDT, TF

EXECUTIVE DIRECTOR,

TREASURER & NORTHEAST

COORDINATOR

Sue Heppenheimer
WESTERN REGION COORDINATOR

Jack Edwards, B.A., C.D.T., M.D.T., T.F.

MIDWEST & CANADA COORDINATOR

Milko Lamos, M.D.T.
SOUTHEASTERN COORDINATOR
Robert Jackson, M.D.T., T.F.

COMMITTEE CHAIRPERSONS

EDUCATION

Vincent V. Alleluia, M.D.T., T.F.

MEMBERSHIP

Sue Heppenheimer

BOARD OF EXAMINERS

Charles Cottone, M.D.T.

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Print Last Name

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Print First Name                                               Middle Initial

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Print Address

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City                                               State                                       Zip Code + four

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Home Phone w/area code                                         Work Phone w/area code

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Fax w/area code                                                       Cell Phone/Beeper w/area code

Educational Profile: ___________________________________

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PRACTICAL EXPERIENCE:

Complete Dentures: ____ Yrs

Ceramics: ____ Yrs

Partial Dentures: ____ Yrs

Orthodontics: ____ Yrs

Crown & Bridge: ____ Yrs

Occlusion: ____ Yrs

Mandibular Physiology:  ____ Yrs

19 DVD set
SPECIAL OFFER

$3000.00

1)    Complete Application and attach a passport-size color photograph of yourself.

2)    Attach payment of $3000.00 Check payable to  DPDC (Dental Development Prosthologist Corporation) to this form. 

3)    Mail check and Form to the above address.


Please note: You are purchasing knowledge and information. Therefore, there are no refunds.

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