Email Address First Name Last Name Job Title Practice Name State/Province Select OneALBERTANOVA SCOTIABRITISH COLUMBIAONTARIOMANITOBAPRINCE EDWARD ISLANDNEW BRUNSWICKQUEBECNEWFOUNDLANDSASKATCHEWANNORTHWEST TERRITORIESYUKON TERRITORYNUNAVUTFOREIGNPlease indicate specialty or type of practice: Select...General PractitionerOrthodontistPeriodontistProsthodontistOral & Maxillofacial SurgeryEndodontistPaediatric DentistryDental AnesthesiaOral MedicineOral PathologistOral RadiologistPublic Health Dentistry, Government, AdminDental StudentCollegeDental SchoolHospitalLibraries & Public LibraryUniversityDental LaboratoryDental Manufacturer & DealerDental AssistantDental HygienistOther (please specify)Since you selected 'Other' in the question above, please specify below: What best describes your type of practice? Select...Solo PractitionerPartnershipGroup Practice (less than 10 dentists)Large Group Practice (10 dentists or more)Dental Service Organization (DSO)Corporate Practice Within a Corporate DSOOther (please specify)Since you selected 'Other' in the question above, please specify below: Please indicate the number of operatories: