AADPA PROMOTING LEADERSHIP, LIFE BALANCE

& SUCCESS IN DENTISTRY WITH —

For Easiest, Fastest & Safest Registration, go to AADPA.org to utilize our Online Registration.

Or, complete and mail this form. Assure Your Spot at this Fabulous Meeting!

Register Early — Register by Nov. 15, 2012, & receive $50 OFF

your 2014 Annual Meeting registration!!

2013 MEETINGREGISTRATION FORM

D • Summer-Fall 2012 • Communicator

Name: n Dr. n Mr. n Ms. n Mrs. nnnnnnnnnnnnnnnnnnnn Badge Name: ______________________

Address_____________________________________________________________________________________________________

City/State/Zip ________________________________________________________________________________________________

Phone (______) _____________________________E-Mail ________________________________ Fax _______________________

In an effort to get to know each other better, please provide a word or two for your badge as a conversation starter: “Ask me about________________________________________________.”For guest dentists: Is this your first AADPA meeting? o Yes o No How did you hear about AADPA? ________________________

Three-day meeting (All Sessions, Thursday through Saturday, March 7 through March 9, 2013): INCLUDES Wednesday Evening Reception/Buffet Dinner, Installation & President Induction Luncheons

FULL PROGRAM Fee Per Person Cost

o (1) Active Member of AADPA — Included in dues ...................................................................................NC $NCo (2) Senior Active Member .........................................................................................................................$400 $________o (3) Life Member .........................................................................................................................................$400 $________o (4) Spouse of AADPA Member.................................................................................................................$450 $________o (5) Team of AADPA Member....................................................................................................................$450 $________o (6) Guest Dentist/Guest Consultant .........................................................................................................$995 $________o (7) Spouse of Guest Dentist/Guest Consultant........................................................................................$550 $________o (8) Team of Guest Dentist/Guest Consultant .................................................................................................$550 $________o (8a) Dental Student/Resident......................................................................................................................$550 $________OPTIONALo (9) New Member/Officer Installation Luncheon, Thursday, March 7, 2013

_____ Will attend _____ Will not attend (included with full registration)

o (10) Lunch & Learn, Friday, March 8, 2013 (Must mark 1, 2, &3 choices on page E) ......................$60 per person $________

o (11) Glittering Glass Luncheon, Friday, March 8, 2013.......................................................................$60 per person $________

o (12) Las Vegas Show-Cirque du Soleil’s Zarkana at The Aria Resort, Friday, March 8, 2013, 7 p.m. $150 per person $________

o (13) President Installation Luncheon & 2014 Program Preview, Saturday, March 9, 2013 _____ Will attend _____ Will not attend (included with full registration)

o (14) Tours, Saturday, March 9, 2013, 2:00 p.m. to 5:30 p.m..................................................................................... $____________ Hoover Dam Inside & Out - $75 pp _____ Explore Vintage Vegas (Neon Boneyard & Mob Museum) - $105 pp

o (15) Las Vegas Show - The Jersey Boys at Paris Las Vegas, Saturday, March 9, 2013, 8:15 p.m. .........$100 per person $________

TOTAL DUE ............................................................................................................................................................. $________

METHOD OF PAYMENT: o Check enclosed (made out to AADPA)

METHOD OF PAYMENT: o Credit Card: o MasterCard o VISA Card # ____________________________Sec. Code________

METHOD OF PAYMENT: Expiration Date____/____Signature________________________________________________________

METHOD OF PAYMENT: Name on card: ________________________________________________________________________

Late fee or Cancellation fee charge after February 11, 2013 is $150 per person + Hotel Cancellation Fee $150/room.

Please print, only one person per registration form...you may copy this form. Deadline: February 11, 2013 — Limited Attendance.

WEB SITE: AADPA.ORG OFFICE USE ONLY

Date Received ______________________Member #__________ Check #__________ Amount $__________

To Register Online: Go to AADPA.org, click on Register Now. then you’ll be taken to the Registration Home Page.Or, remove this 4-page registration form, make necessary copies, complete form(s),

FAX registrations to 847-934-4410 or enclose your check before February 11, 2013 and mail to:AADPA c/o KATHLEEN UEBEL, EXECUTIVE DIRECTOR • 1063 WHIPPOORWILL LANE • PALATINE, ILLINOIS 60067-7064MAKE RESERVATIONS AT THE COSMOPOLITAN EARLY!! - VIA ONLINE OR MARRIOTT RESERVATIONS 702-698-7000.

TELL THEM YOU ARE WITH AADPA. OUR RESERVATION DISCOUNT CODE IS AADPA2013.

Communicator • Summer-Fall 2012 • E

If you have any questions on any fees or categories, please call us at 847-934-4404 or 970-223-1743. For room selection and materials planning, please indicate 1st and 2nd choices for breakout sessions.

Course tickets transferable whenever space allows.1st/2nd Choice Speaker/Topic

THURSDAY, MARCH 7, 2013 — KEYNOTE OPENING SESSION, 8:15 A.M.-9:30 A.M.(16) _____ Mr. Bob Danzig: The Leader Within You

THURSDAY, MARCH 7, 2013 — THURSDAY A.M. BREAKOUTS(17) _____ Drs. Berlin, Sindelar, & Mongrain, : The Practice of the Future(18) _____ Ms. Kristie Nation: Social Media Success in Your Practice

THURSDAY, MARCH 7, 2013 — THURSDAY P.M. BREAKOUTS(19) _____ Drs. Berlin, Sindelar, & Mongrain, : The Practice of the Future (continued)(20) _____ Mr. Bob Danzig: Leadership Workshop

THURSDAY, MARCH 7, 2013 — THURSDAY LATE P.M. BREAKOUTS(21) _____ Dr Joe Blaes: Hands on Workshop 14 Great NEW Products MUST REGISTER TO ATTEND(22) _____ Mr. Allen Schiff: Your Money, Your Practice, and Your Future

FRIDAY, MARCH 8, 2013 — KEYNOTE OPENING SESSION, 8:00 A.M. - 10:00 A.M.(23) _____ Dr. Bradley Bale & Ms. Amy Doneen: The Bale/Doneen Method of Heart Attack and Stroke Prevention

FRIDAY, MARCH 8, 2013 — FRIDAY A.M. BREAKOUTS(24) _____ Dr. Bradley Bale & Ms. Amy Doneen: The Bale/Doneen Method of Heart Attack and Stroke Prevention, continued(25) _____ Dr. William Howard: Common Injuries in Youth Athletics (26) _____ 3D Summit: Expand Your Practice with Digital Dentistry

-Dr. Joe Blaes - Growing the Progressive Practice &-Dr. Don Tyndall - 3D Radiography - Seeing Things from a New Perspective

FRIDAY, MARCH 8, 2013 — LUNCH & LEARN,12:00 noon-1:20 P.M. (Indicate on the Registration Page)Please indicate 1st, 2nd and 3rd choice in the space in front of the table number. Tickets issued on a first-come, first-serve basis. We have16 tables with 9 tickets for each table. Make selections early. You must have a reservation and a ticket to attend. Cost for session is $60.

All Tables open to both dentists and team members — However, those with asterisks( *) are especially beneficial to team as well as dentists.

___ 1. Dr. Kent Smith *Is it Time to Offer 6-Month Smiles in YourPractice?

___ 2. Mr. Paul Sletten Changing Trends in Practice Transitions___ 3. Dr. Carl Jepson *Smart Goals Through Affirmations___ 4. Mr. Rick Willeford How To Invest To Win The Loser's Game___ 5. Dr. Larry Emmott Your On-line Footprint___ 6. Dr. Mike Robichaux *Establishing Trust Early in Relationships___ 7. Ms. Linda Drevenstedt *Keeping Hygiene Full in This Crazy Economy___ 8. Dr. Mike Lewis The Poetry of Passion, Purpose, and

Prosperity___ 9. Dr. Bob Frazer *Four Emotional Intelligence Keys For

Maximum Case Acceptance___ 10. Dr. Charles Blair *Stay Out Of Jail: CDT-2013 Code Update___ 11. Dr. Randy Shoup Decay Free Dentistry, Systems To Eradicate

Cavities

___ 12. Ms. Lois Banta *Top 10 Management Tools Every PracticeNeeds

___ 13. Dr. Bob Hamric *5 Easy Ways To Add To Your Bottom Line___ 14. Dr. Randy Jungman Kids Super Saturday — Cater to Kids & Grow

Your Practice While Having a Fun ThemeDay

___ 15. Dr. Barry Moskowitz *Creating the Exemplary Team — Selection,Nuturing & Retention

___ 16. Dr. William Gregg Leadership in Practice and Life___ 17. Ms. Linda Lakin *Don't Let Your Patients Fall Through The

Cracks: The Art of Follow Up___ 18. Dr. Matt Steinberg How To Set Up A Sleep Disorder Program In

Your Practice___ 19. Ms. Linda Miles Creating the Exceptional Dental Practice

Administrator

FRIDAY, MARCH 8, 2013 — FRIDAY P.M. BREAKOUTS(27) _____ Ms. Kristie Nation: Social Media and Networking(28) _____ Dr. Brad Bale, Ms. Amy Doneen, Drs. Tom Nabor, Dan Sindelar, and Chris Kammer: Oral Systemic Connection Workshop(29) _____ 3D Summit: Expand Your Practice with Digital Dentistry

-Dr. August Oliveira - Growing the Progressive Practice & -Mr. Roddy MacLeod - Diverse Capabilities of CEREC and Patient Acceptance

SATURDAY, MARCH 9, 2013 — KEYNOTE, 8:00 A.M.-9:00 A.M.(30) _____ Mr. Imtiaz Manji: Adapting to the New World of Dentistry

SATURDAY, MARCH 9, 2013 — SATURDAY A.M. BREAKOUTS(31) _____ Ms. Loid Banta: Putting the FUN Back in Dentistry(32) _____ 3D Summit: Expand Your Practice with Digital Dentistry

-Dr. Tarun Agarwal - Practical Use of CAD / CAM and Conebeam in a Successful Practice &-Dr. Joe Blaes -Optimal Use of Dental Team to Increase Practice Performance Using 3D Digital Dentistry

SATURDAY, MARCH 9, 2013 — SATURDAY EARLY P.M. BREAKOUTS(33) _____ Ms. Linda Drevenstedt: 7 Brain Principles that Maximize Effectiveness™(34) _____ Dr. Rhonda Savage: Challenges Facing Women in Dentistry

SATURDAY, MARCH 9, 2013 — SATURDAY LATE P.M. BREAKOUTS(35) _____ Dr. Wendy Bach: Women’s Mastermind Group(36) _____ Mr. Allen Schiff: Dental Practice Transitions

F • Summer-Fall 2012 • Communicator

Tours —Saturday, March 9, 2013 2:00 pm-5:30 pm

Hoover Dam - In & Out

Get a close up and personal tour of this man-made wonder of

the modern world. See the video presentation of “How the

West was Won” which describes the contribution of the Bureau of

Reclamation in taming the rivers and its contribution in helping

settle the West and growing the food that feeds the nation. Next

it’s off to the Power Plant Generators, You will take large elevators

500 Feet down into the wall of the Black Canyon where you will

walk through the 250 Ft. long tunnel drilled out of rock and view

the 650 Ft long Nevada wing of the power plant and its 8 huge

generators. Finish

your time at Hoover

Dam by visiting the

exhibit halls and

observation deck.

This tour is the way to

see, learn and

appreciate what

Hoover Dam is all

about.

$75/per person

Tour one of the world's most recognizable cities. The tour starts

at the Mormon Fort located on Las Vegas Blvd, where you hear

the history of early

Nevadan settlers and how

Las Vegas transformed

into the bustling town it is

today. Next up the Neon

Boneyard where you’ll see

classic Las Vegas art forms.

Dedicated individuals

from the private,

corporate and government

sectors work tirelessly to preserve these national treasures. The

Museum's mission is to collect, preserve, study and exhibit iconic

Las Vegas neon signs for educational, historic and cultural

enrichment. Then you will continue to the Mob Museum, where

fact and fiction are exposed and a light is shed on how the Mob

came to be, the battles that were fought, and what remains today.

Enjoy a fascinating afternoon.

$105/per person

Explore Vintage VegasOR

Optional Las Vegas Shows

Friday, March 8, 20137:00 pm • The Aria Resort

If you have never seen a Cirque du Soleil presentation.... you

cannot miss this opportunity!! And, if you have been to a

show, you know you ALSO won’t want to miss a BRAND NEW

Show!! These are not just shows, they are everything rolled into

the most amazing, visual spectacular you will ever see. Tickets are

limited — so register today!!

$150/per person

Saturday, March 9, 20138:15 pm• Paris Las Vegas

The Jersey Boys

Enjoy the story of Frankie Valli and The Four Seasons and

how a group of blue collar boys from the wrong side of the

tracks became one of the

biggest American pop music

sensations of all time. They

wrote their own songs,

invented their own sound

and sold 175 million records

worldwide — all before they

were thirty. The show

features hits such as

“Sherry”, “Big Girls Don’t

Cry”, Can’t Take my Eyes Off

of You”, and “Oh What A

Night” and many more.

$100/per person