WLADS CE Speaker Application

Thank you for your interest in being a speaker for the Western Los Angeles Dental Society! Please provide us with your information below and it will be reviewed by our Programs Committee.

Question Title

* 1. Name

Question Title

* 2. Email Address

Question Title

* 3. Phone number

Question Title

* 4. Do you offer virtual or in-person courses?

Virtual

In-Person

Both

Question Title

* 5. Are you licensed to provide CE credits?

Virtual

In-Person

Question Title

* 6. What topics/courses do you offer?

Question Title

* 7. Please provide your course description and/or learning objectives

Question Title

* 8. Honorarium range

Question Title

* 9. Please let us know if you have any questions or concerns!