^{Profitable, Image-Enhancing Solutions}

Public Relations Agreement

Please fax your completed agreement to 312-455-9491 or email to DBobrow@AmericanDentalCo.com

Practice Name: ___________________________________________

Doctor's Name: ___________________________________________

Phone: ___________________________

Email: ___________________________

Website: ________________________________________________

Street:__________________________________________________

City: _____________________________________State: _________

Zip/Postal Code: _______________ Country: __________________

Service Description:

Promote Participant’s ownership and use of VELscope and other newsworthy topics to local area print and broadcast media.

Below please provide the names of all media you would like us to contact (maximum of four):

Name of Media

1.

2.

3.

4.

Note: If you would like us to conduct a search for appropriate media in your Service Area, please advise your marketing specialist.

Press Release Design and Placement Fee: $250 Per Medium To Be Contacted On Behalf of Client

I have read and understand this Agreement and agree to abide by its terms.

Print Name Here: ___________________________________________

Accepted By: ___________________________________________

Signature

Date: _____________________