DSN Live CE Checklist This form allows potential Instructors to submit Live CE events to be submitted on the website. Step 1 of 3 33% Name* First Last Email* Course Name* Preferred Start Date* MM slash DD slash YYYY Pending approval based on availabilityPreferred End Date* MM slash DD slash YYYY Pending approval based on availabilityCourse FeeSeparate into price for Members, Non-members and StaffMembers Price*Members PriceNon-members Price*Non-members PriceStaff Price*Staff PriceAre there any documents that need to be sent to students prior to attending the course? Drop files here or Select files Max. file size: 128 MB. What DSN Facility will the course be held at?* Scottsdale Indianapolis Will the Registrant be required to buy any products to participate in the course? What are they and how much should they be expecting to pay?*Course Synopsis*Instructor Information*Educational Objectives*Disclosure* Minimum Number of Attendees to make the course work?*Please enter a number from 0 to 60.I understand that if my minimum # of attendees isn't hit, I have the option to cancel at least 21 days in advance. Understood?* Yup. No....what? Maximum Number of Attendees allowed?*Please enter a number from 0 to 60.What Vendors will be at the course?*Please list all vendors.Are Models or hands on materials required?*Please explain and list.Are live patients required?* Yes No I have supporting documents and have uploaded them below Drop files here or Select files Max. file size: 128 MB. Do Attendees Need to Bring anything?*Please list everything below.CE is a 1:1 ratio which means an hour gets 1 credit, half an hour gets 0.5 credits.* Yes I get it No How many CE credit hours is this course worth?* What is the course category?*010 Basic Science070 Endodontics130 Electives180 Occlusion200 Orofacial Pain250 Operative (Restorative) Dentistry310 Oral and Maxillofacial Surgery340 Anesthesia and Pain Management370 Orthodontics430 Pediatric Dentistry490 Periodontics550 Practice Management610 Fixed Prosthodontics670 Removable Prosthodontics690 Implants730 Oral Medicine, Oral Diagnosis, Oral Pathology750 Special Patient Care770 Self-Improvement780 Esthetics / Cosmetic DentistryWhat is the itinerary for the event days?* Drop files here or Select files Max. file size: 128 MB, Max. files: 4. Please upload a Spreadsheet or Document with planned speaking times, breaks, clinical time, and any other information. Upload Rental Agreement*Max. file size: 128 MB.Please upload a sign copy of your Rental Agreement. You can find this in your "Let's Get Started" email.