PHELAN DENTAL SEMINARS WORKSHOP REGISTRATION FORM

Practical Techniques That Will Make Occlusion Work In Your Practice

February 11th and 12th, 2011
Workshop Synopsis
• Over the shoulder demonstrations of the techniques used by Dr. Stephen Phelan.
• Learn a predictable technique to record the joint and bite position for your patient that is repeatable and accurate.
• Practice taking diagnostic bite records using a leaf gauge and a Kois Deprogrammer and determine which technique is
best suited for different clinical situations.
• Practice facebow transfers, and mounting of your cases on the Sam 3 articulator.
• How to verify that your bite record and articulator mounting is correct.
• Learn a predictable and step-by-step technique to equilibrate and balance your patients bite.
• When and how to open a patients vertical dimension.
• How to design the patient's occlusion and know that it works before creating the final restorations.
• Learn how to take bite records for larger restorative cases including implant reconstructions.
• Learn the steps to make a variety of splints and deprogrammers to protect your patients' teeth and restorations.
• The use of high-powered magnification with a dental microscope will be demonstrated and participants will have the
opportunity to try out the microscope on one another.

Doctor’s Name: _____________________________________________________________________________

Address: __________________________________________________________________________________

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The tuition fee for the workshop is $3000.00 plus HST ($3390.00). I would like to offer a payment plan option for all of you
that have supported my previous seminars. The payment plan option consists of a deposit of $1000.00 plus HST ($1130.00)
to reserve your place at the seminar and 4 additional monthly payments of $500.00 plus HST ($565.00), starting the 15th of
October and finishing on the 15th of January 2011.
Payment Option: □ Payment in full [One time fee payment of $3390.00]
□ Payment Plan [$1130.00 deposit, plus 4 more payments of $565.00]
For Payment Plan Option:

□ I authorize Phelan Dental Seminars to charge my deposit of $1130.00 today and then a payment of $565.00
on the following dates October 15, 2010, November 15, 2010, December 15, 2010 and January 15, 2011 to the
credit card below.

Payment Method: □Visa □Mastercard □AMEX

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Expiry: (month/year) ________________________Card Verification Number:____________________________

Name on Card:______________________________________________________________________________

Signature:__________________________________________________________________________________

Date:______________________________________________________________________________________

Fax to (905) 989-1594 or Call (800) 964-1619