Thank you for presenting the Oral Health Prevention Primer. Please provide the information requested below. Once completed, we will send you the presentation.

We look forward to your feedback on the materials and event.

 Thank you.

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* 1. Contact Information:

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* 2. If you are making this request on behalf of the presenter, please provide the information below.

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* 3. Is the presenter a Fellow of the American Academy of Pediatrics?

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* 4. If this will be a collaboration, please provide name(s) of the other organization(s).

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* 5. If presentation will be held in conjunction with an AAP Chapter, and that information is not already included above, please provide Chapter contact person:

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* 6. Will the Chapter Oral Health Advocate (COHA) be involved in this presentation?

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* 7. Please describe the anticipated setting and audience for this presentation.

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