EEC Institute Inc. is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from December 1, 2010 to November 30, 2011. Provider ID# 331968

2012 AAID New York Study Club Membership Application

ONLINE REGISTRATION

CE credits issued by EEC Institute, Inc-Approved AGD credits

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NAME: First, Initial(s), Last, Degree(s) *(As you wish it to appear on membership certificates, etc.)
ADDRESS: Street, Apt/Suite # *
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EDUCATION: Undergraduate *
Degree *
Date *
EDUCATION: Dental *
Degree *
Date *
EDUCATION: Post-Doctoral
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Date
EXPERIENCE: # of yrs involved in Implant Dentistry *
Primary Interest *
Implant Surgery
Implant Prosthetic
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ORGANIZATION AFFLILIATIONS:
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