2024 Life in the Real World - Cleveland

The ODA Subcouncil on New Dentists is hosting an exciting evening, just for new dentists, dental residents and dental students, to hear from new dentists a few years in practice as they reflect upon their journey from school to now.

Friday, November 1, 2024
7:00 p.m. - 10:00 p.m.

Topgolf Cleveland
5820 Rockside Woods Blvd N, Independence, OH 44131

This fun and FREE evening includes dinner, drinks, golf and 1 hour of CE!

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* 1. I will be attending the Life in the Real World event at Topgolf Cleveland on Friday, November 1, 2024.

Yes

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* 2. Please indicate your current position.

I am a dental student.

I am a dental resident.

I am a dentist.

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* 3. Please indicate your dental school and year of graduation.

Dental School:

Graduation Year:

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* 4. Please provide your Advanced Education Program, if applicable.

School/Hospital:

Program Start Date:

Expected Completion Date:

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* 5. Please indicate your Advanced Education Program Specialty, if applicable. (please select one)

Anesthesiology

Endo

General Practice

Orafacial Pain

Oral Medicine

Oral Pathology

Oral Radiology

Oral Surgery

Ortho

Pediatric

Perio

Prostho

Public Health

Other (please specify)

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* 6. Please provide your general information.

First Name *

Middle/Maiden Name *

Last Name *

ADA number (if known)

Date of Birth *

Gender *

License Number

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* 7. Please provide your full contact information.

Office Address (if applicable)

Office City, State ZIP (if applicable)

Home Address *

Home Address 2

City *

State *

ZIP *

Non-school Email Address *

Cell Phone Number *

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* 8. Please indicate how many will be attending this event.

2 (my spouse/significant other is also a dental student, dental resident or new dentist)