Study Club Membership Form

Oral Maxillofacial Surgical Associates is pleased to offer open participation and/or membership to the Suburban Implant Study Club (SISC).

SISC was established in 1992 to provide restorative dentists access to the most current information available regarding dental implant reconstruction. SISC meets locally at Talamore Country Club in Ambler, PA four times per year in a seminar format with national and local speakers. The seminars run approximately 3-4 hours in length. Dinner and drinks are provided to all participants.

Continuing Education credits (AGD/CME) will be provided at the rate of one credit per hour. This will meet the state requirement for dental professionals to renew licenses, where thirty credits are needed within two year duration.

The dues for this years Study Club Meetings will be $380.00

SUBURBAN IMPLANT STUDY CLUB
Membership Registration Form

NAME:

PRACTICE NAME:

PARTNER(S)/ASSOCIATE(S):

OFFICE ADDRESS:

PRIVATE PHONE #:

OFFICE PHONE #:

FAX #: ___________________________ STAFF SIZE: _______________

HOME ADDRESS:

HOME PHONE: ______________________

SPOUSE NAME: _________________________

COLLEGE ATTENDED:

DENTALSCHOOLATTENDED:

YEAR GRADUATED:

DEGREE:

PENNSYLVANIASTATELICENSE #:

If interested, please mail application with the dues to the following address:

OMSA Attention Study Club

2100 North Broad Street, Suite 106

Lansdale, PA19446

Please contact Neha Thaker at 215.368.8104 with any questions or concerns.
Thank you for participating in the Suburban Implant Study Club.