Personal Information

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Registration Type

General Registration

Primary Professional Role

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Specialty Area

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How did you hear about this program?

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Are you a Harvard alum?

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Are you an ITI fellow with HSDM?

Do you plan to attend the Alumni Reception on Thursday, February 26th?

Please add me to the HSDM Continuing Education email list to receive information about upcoming courses. 

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Photo Release: I understand that a photograph, film, video or motion picture of me, or a sound recording of my voice, may be taken or made by Harvard School of Dental Medicine, its employees, agents, or persons acting under their authority. For good and valuable consideration, whose receipt and sufficiency is hereby acknowledged, I hereby authorize Harvard School of Dental Medicine to make, reproduce, copy, sell, exhibit, publish, distribute, and otherwise use for publicity, fundraising, advertising, teaching purposes or any other lawful purpose such photographs, films, videos, motion pictures, and sound recordings; and I hereby release and discharge Harvard School of Dental Medicine, its officers, agents, representatives, successors, assigns, and all persons acting under their permission or authority, of and from all liability of any nature whatsoever arising there from. Furthermore, I assign all right, title, and interest I may have in any such materials to Harvard School of Dental Medicine, and expressly waive any approval rights I may have with respect to such materials. This release shall take effect as a sealed instrument, and I hereby certify that I am at least (18) eighteen years of age.

I agree to the Photo/Video/Audio Release outlined above.

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