COURSE ATTENDANCE VERIFICATION

Participant's Name: Jason Larsen

State and License #: Texas 25790

Participant AGD ID#: Na

Course: Collaborative Orthodontic Care Provides the Best Care For our Patients

SPEAKERS: Dr. Lou Chmura

Educational Method: Self Study

CE Hours: 1

Educational Type: Self Study

Course Date: December 13, 2023

AGD Code:

370 Orthodontics

Verification Code: DFX-LC1

Authorized Signature:

PARTICIPANTS:

This activity has been planned and implemented in accordance with the standards
of the Academy of General Dentistry Program Approval for Continuing Education (PACE)
through the joint program provider approval of Delivering WOW and Dentalflix.
Delivering WOW is approved for awarding FAGD/MAGD credit.

Keep this form for your records.

AGD Members: Delivering Wow will submit attendance verification to the AGD on your behalf.
Please allow at least 30 days for documentation of participation to be added to your transcript