Answer the questions below and be entered in a drawing for an iPad II.

First Name:                      Last Name:

Title:                            Practice Name:

Address:                                        City:   

State:                                    Zip Code: 

Phone #:                   Email Address:  

Webiste:

Winner Preference:

Option 1: iPad II

Option 2: Accu-Dent System 1 Impression System

Interests:

Are you interested in a centrally located, same day repair center with a patient waiting lounge?

Are you interested in on-site repairs (van repair service with certified technician)?

Are you interesed in technical chairside assistance?

The winner of the iPad II will be announced online on March 1, 2012.

Apple is not a participant in or sponsor of this promotion.