COURSE ATTENDANCE VERIFICATION

Participant's Name: Sahar Salem

State and License #: H9267

Participant AGD ID#: 123456

Course: Periodontal Classification Series Part 3 – Clinical Assessments for Periodontal Disease

SPEAKERS: Katrina Sanders

Educational Method: Self Study

CE Hours: 1

Educational Type: Self Study

Course Date: March 9, 2024

AGD Code:

490 Periodontics

Verification Code: DFX-KS3

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