Complete this form to request a program that provides an overview of the periodontics specialty to the predoctoral dental students at your school. Members Only Content: Not Member OnlyYOUR CONTACT INFORMATION Your Name: * Dental School: * Email Address: * Mailing Address: * Phone Number: * YOUR LUNCH 'N LEARN PROGRAMPlease tell us about the kind of program you want. Date and Time Desired: * Estimated Number of Attendees: * Area of Periodontics to Focus on: * Private Practice Academic Career Check Topics That Interest You: Day in the Life of a Practicing Periodontist Postgraduate Periodontal Training Different Types of Procedures (i.e. implants, root planing, etc.) Other Topic Suggestions: Preferred Presentation: * PowerPoint Slides More Informal Program Comments: