Continuing Dental Education Registration Form

NOTE: Please register one person per form submission. To register multiple people, return to this page and submit a new form for each person.

This form is for paying by credit card only. If you want to pay by check or purchase order, you must go back to the Courses page and download the PDF, fill it out and mail it to us. We cannot accept an online registration for checks. Thank you.

Name:
Title:
(as it should appear on your tag...DR., MR., MRS., MS.)
Employer's Name:
(Staff registrants only)
Office Address:
City:
State:
Zipcode:
Office Phone:
Emergency Phone:
Email:
(Registration Confirmation will be sent via Email Only one week prior to the course)

Registration Categories (select one only)

DSDS/ADA Dentist
Non-DSDS/ADA Dentist
Dental Hygienist
Dental Assistant
Office Manager/Staff
Resident
Student
Spouse

REGISTRATION FEE:

2016 Five Program Package - One Dentist & One Staff Person
DSDS/ADA Member - $1300.00 NonADA Member - $1775.00 Staff/Student/Resident/Spouse - $700.00
January 22, 2016
The 3 Drivers of Sustained Practic Growth and Success/Simplifying the Complex Case - Mark T. Murphy, DDS
DSDS/ADA Member
$290.00 - before Jan 8
$315.00 - after Jan 8
NonADA Member
$390.00 - before Jan 8
$415.00 - after Jan 8
Staff/Student/Resident/Spouse
$150.00 - before Jan 8
$175.00 - after Jan 8
March 11, 2016
Team Approach To Fighting Gum Disease/Dental Coding: Tricks of Our Trade - Patricia A. Worcester, RDH/ Roz Fulmer, CEO
DSDS/ADA Member
$290.00 - before Feb 26
$315.00 - after Feb 26
NonADA Member
$390.00 - before Feb 26
$415.00 - after Feb 26
Staff/Student/Resident/Spouse
$150.00 - before Feb 26
$175.00 - after Feb 26
September 23, 2016
Let's Talk About Infection Control & OSHA - John A. Molinari, Ph.D.
DSDS/ADA Member
$290.00 - before Sep 9
$315.00 - after Sep 9
NonADA Member
$390.00 - before Sep 9
$415.00 - after Sep 9
Staff/Student/Resident/Spouse
$150.00 - before Sep 9
$175.00 - after Sep 9
October 14, 2016
Guidelines For Better Esthetic & Restorative Dentistry From A To Z: $315 - after Sep. 30 $415 - - Alan M. Atlas, DMD
DSDS/ADA Member
$290.00 - before Sep 30
$315.00 - after Sep 30
NonADA Member
$390.00 - before Sep 30
$415.00 - after Sep 30
Staff/Student/Resident/Spouse
$150.00 - before Sep 30
$175.00 - after Sep 30
November 18, 2016
Utilizing Laser Technology in a Periodontal Environment / Innovative Periodontics: Creating Success - Samuel B. Low, DDS, MS, M.Ed
DSDS/ADA Member
$290.00 - before Nov 4
$315.00 - after Nov 4
NonADA Member
$390.00 - before Nov 4
$415.00 - after Nov 4
Staff/Student/Resident/Spouse
$150.00 - before Nov 4
$175.00 - after Nov 4


TOTAL REGISTRATION $0

 
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