DANB’s 2011 State Career Ladder Templates for Dental Assistants is a reader-friendly guide outlining dental assistant requirements and career opportunities for dental assistants in all 50 states.

DANB’s 2011 State Fact Booklet provides current state requirements and excerpts from State Practice Acts re-lated to dental assisting. It also features State Board of Dentistry contact information, accepted/required DANB exams, the number of DANB Certificants in each state, a list of CODA-accredited programs and comparative salary information.

Unit Cost (circle one) Quantity TOTAL

Name (print or type)_____________________________________________________________ SSN*_________________________________________

Organization Name (only if sending to work address) ________________________________________________________________________________

Address (no P.O. Box numbers)_______________________________________City____________________State__________Zip___________________

Daytime Phone Number (_____)_________________________________ E-mail _________________________________________________________

Please print clearly.

*Social Security Number assists DANB in properly processing the candidate’s order.M

DANB’s 2011 State Career Ladder Templates for Dental Assistants

Shipping (U.S. standard rate) and handling are included in the cost. Please allow 3-4 weeks for shipping.

Overnight shipping is available for $20. For overnight shipments of more than 10 books or for an international delivery request, please call 1-800-367-3262. Orders for overnight shipping must be received by DANB no later than 2 p.m. CST.

The Dental Assisting National Board, Inc. (DANB) 2011 State Publications

DANB’s state publications are a complete guide to national dental assisting regulatory requirements. DANB exams are recognized or required in 38 states, the District of Columbia, the U.S. Air Force and

the U.S. Department of Veterans Affairs.

Questions? 1-800-367-3262 • www.danb.org

Name (print or type)____________________________________________________ SSN*___________________________________________________Credit Card Number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiration Date __ __/__ __ Amount $_________________________

Cardholder’s Name______________________________________________Cardholder’s Signature___________________________________________

Cardholder’s Billing Address_____________________________________________________________________________________________________

City/State/Zip_____________________________________________________________Phone Number (_______)________________________________

VISA MASTERCARD DISCOVER AMERICAN EXPRESS

Credit Card Authorization: Allows DANB to charge your credit card account. Please complete all information.

Cashier’s Check/Money Order payable to the Dental Assisting National Board, Inc. or DANB

By signing, the cardholder acknowledges purchase of the aforementioned DANB publications in the amount of the total shown hereon and agrees to perform the obligations set forth in the cardholder’s agreement with the issuer. Furthermore, the cardholder understands that the signature obtained on this form shall be used to indicate receipt of purchase. All DANB publication fees are nonrefundable.

All DANB publication fees are nonrefundable.

MAIL to:Dental Assisting National Board, Inc. DANB Publications444 N. Michigan Ave., Suite 900Chicago, IL 60611-3985

FAX to: 312- 642-8507

or

Please indicate payment information below.DANB no longer accepts purchase orders or personal checks for publication orders.

State Guide Pack *special rate*: DANB’s 2011 State Career Ladder Templates for Dental Assistants and DANB’s 2011 State Fact Booklet

DANB’s 2011 State Fact Booklet

DANB Certification Number ___ ___ ___ ___ ___ ___

Certificant Professional

$100

$65(3480-11)

$60

$65(3440-12)

$40(3440-10)

$40(3480-10)

ORDER TOTAL

$_________

$_________

$_________

$_________

_________

_________

_________ $_________

Overnight shipping fee