Friday, July 26, 2013

UCLA Faculty Center

480 Charles E. Young Drive East
Los Angeles, CA 90095

Please join the Section of Pediatric Dentistry and the Friends of Pediatric Dentistry as we celebrate the graduating Class of 2013 and the

Silver Anniversary of the Class of 1988

Charles Low (Westwood) Gary U. Okamoto (Westwood)
Paul J. Styrt (Ortho/Pediatric Dentistry)     Maryen C. Vemuri (Westwood)

Schedule of Events
12:30 pm Doors open
1:00 - 2:00 pm CE Program - Class of 2013 Resident Research Presentations
2:15 - 6:00 pm CE Program - Guest Speaker: Dr. Marcio Guelmann
  "Evidence-based Pulp Therapy for the Primary Dentition"
5:30 pm Social Hour
7:00 pm Dinner and Evening Program

Required fields are indicated with an asterisk (*).
Your contribution is greatly appreciated!
      Staff member or Incoming/Current Resident (No charge)
      Afternoon (CE), social hour and dinner - $150 ($0 per ticket is tax-deductible)
      Afternoon (CE) and social hour only - $75 ($0 per ticket is tax-deductible)
      Dinner and evening program only - $100 ($0 per ticket is tax-deductible)
      Guest Tickets (social hour and evening program only) - $60 ($0 per ticket is tax-deductible)
      Sponsor a resident's attendance - $75 ($75 tax-deductible)

I would like to contribute an additional gift or I am unable to attend but would like to support UCLA Pediatric Dentistry.
I would like to make a fully tax-deductible gift of    Other $  

Grand Total:

* First name:  
  Middle name:
* Last name:  
UCLA graduation year(s):  

  UCLA graduation year(s):

Joint Gift
* This is a joint gift with my spouse/partner:

Contact Information
* Street:  
U.S. Addresses  
*   City, State, Zip:
Non-U.S. Addresses  
  Non-U.S. City/County
  or Province/Postal Code:
* This address is my:  
* Home telephone:    
Business telephone:  

* E-mail address:  
* This e-mail is my:  

Matching Gift

  My/my spouse's employer will match my gift.
  Company name for matching gifts:
  This company is:
If your transaction includes a payment, please select method.
Payment method:
This gift is anonymous
Guest Information

Please indicate the names and meal selections of all guests, including yourself.

Meal options:

  • Baked breast of chicken Moroccan with golden raisins, almonds and spiced apple nage, served with coucous
  • Crab crusted wild mahi mahi with lightly curried corn coulis and French tarragon
  • Seasonal vegetable paella with Spanish saffron risotto, fennel, artichokes, and teardrop tomatoes
 Your Name:
 Your Meal:
 Guest 1 Name:
 Guest 1 Meal:
 Guest 2 Name:
 Guest 2 Meal:
 Guest 3 Name:
 Guest 3 Meal:
 Guest 4 Name:
 Guest 4 Meal: