Application and Evaluation Forms     Membership Application (To download this application, highlight it by left clicking while dragging the cursor over its contents, then right click the highlighted text and click print.  Check "Selection"  in the Print dialogue box and then click "OK".) [SEDA] APPLICATION FORM PLEASE FILL OUT AND SEND WITH YOUR PAYMENT We need your: NAME, ADDRESS, E-MAIL, PHONE # and LICENSE # ! DOCTOR/CDT:_______________________________________________ ___________________________________________________________ STAFF:_____________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Please make your check payable to [SEDA]. Number of doctors and/or CDTs registering____X $175.00 = $____ Number of staff registering ____X $35.00 X____ meetings = $____                                                              Total enclosed = $____ THANK YOU _____________________________[SEDA]____________________________ SEND TO: SEDA P.O. Box 174 Portsmouth, NH 03802 For [SEDA]'s e-mail address, click here.   To register for the upcoming SEDA season with Visa or Mastercard, click here.     Glass Polymer Inlay/Onlay WHAT [SEDA] ATTENDEES ARE SAYING "It was excellent!  Thank you for reading my mind to have Dick back again!  I will definitely bring my entire staff next November.  Again, many thanks and praises!" Dr. John Maloney of Seabrook, NH after the 10/4/2002 [SEDA] meeting with Dr. Dick Barnes.   "Dr. Goldstein's course was very informative.  Good job.  Thank you!" Dr. David Staples of Dover, NH after the 10/3/2003 [SEDA] meeting with Dr. Marty Goldstein.   "Thank you Barry and Lisa for your dedication to SEDA.  Every year tops the previous." Dr. Ben Selle of Wolfeboro, NH on receiving [SEDA]'s 2004/2005 season schedule.   "This was a great course, all of the information was useful and helpful.  Nice guy too." Dr. Doug Grey of York, ME after the 5/13/2005 [SEDA] meeting with Dr. Edward McLaren.   "Thank you for letting me be a part of your study group. Dr. McKee's lecture was excellent and the company was great.  Nice job making the CDTs feel welcome." Mr. Armand Pepin, CDT of AP Dental after the 10/14/2005 [SEDA] meeting with Dr. Jim mcKee.   "I thought it was a great lecture! Thank You! " Mr. Les Rusczyk, CDT of Seacoast Dental Studio after the 5/6/2006 [SEDA] meeting with Dr. John Cranham.       Course Evaluation (To download this evaluation form, highlight it by left clicking while dragging the cursor over its contents, then right click the highlighted text and click print.  Check "Selection"  in the Print dialogue box and then click "OK".) Seacoast Esthetic Dentistry Association COURSE EVALUATION FORM COURSE TITLE _________________ SPEAKER ______________DATE / / / Please evaluate the above cited course on a scale of 1 - 5 (with a grade of 1 being best and a grade of 5 being worst) by circling your rating for the following criteria: A) Relevance and timeliness of subject matter > 1 2 3 4 5 B) Ability and expertise of the speaker > 1 2 3 4 5 C) Quality of distributed supplemental materials (if applicable) > 1 2 3 4 5 E) Speakers use of illustrative devices > 1 2 3 4 5 D) Adequacy of course venue > 1 2 3 4 5 F) Overall course value > 1 2 3 4 5 Coments: ______________________________________________________ _______________________________________________________________ _______________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _   THANK YOU FOR ATTENDING! To receive credit for your attendance, please print then sign your name below and fill in the date with your AGD identification number if applicable. You must return this evaluation in order to receive continuing education credits. Name_______________Signature_______________Date / / AGD ID#_______ AGD Sponsor Number: 217688 Hours: 3 Subject Code: Course Type: (L/P) _____________________________[SEDA]____________________________ To view [SEDA]'s current schedule, click here. To see a photo gallery of cases done by our members, click here.