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:

2015 Five Program Package - One Dentist & One Staff Person
DSDS/ADA Member - $1300.00 NonADA Member - $1775.00 Staff/Student/Resident/Spouse - $700.00
21st Century Marketing – How Practices Can Thrive in the New Economy - Leonard F. Tau, DMD
January 23, 2015

DSDS/ADA Member
$290.00 - before Jan 10
$315.00 - after Jan 10
NonADA Member
$390.00 - before Jan 10
$415.00 - after Jan 10
Staff/Student/Resident/Spouse
$150.00 - before Jan 10
$175.00 - after Jan 10
Medical Update for the Dental Team - Barbara J. Steinberg, DDS
February 20, 2015

DSDS/ADA Member
$290.00 - before Feb 7
$315.00 - after Feb 7
NonADA Member
$390.00 - before Feb 7
$415.00 - after Feb 7
Staff/Student/Resident/Spouse
$150.00 - before Feb 7
$175.00 - after Feb 7
All You Wanted to Know About Attachment Dentistry But Were Afraid to Ask! - George E Bambara, DMD
March 27, 2015

DSDS/ADA Member
$290.00 - before Mar 14
$315.00 - after Mar 14
NonADA Member
$390.00 - before Mar 14
$415.00 - after Mar 14
Staff/Student/Resident/Spouse
$150.00 - before Mar 14
$175.00 - after Mar 14
Beyond Integration: Blue Print for Restorative Success - Wael Garine, DDS
September 18, 2015

DSDS/ADA Member
$290.00 - before Sep 5
$315.00 - after Sep 5
NonADA Member
$390.00 - before Sep 5
$415.00 - after Sep 5
Staff/Student/Resident/Spouse
$150.00 - before Sep 5
$175.00 - after Sep 5
New Data on Critical Dental Questions, including Infection Control - Rella P. Christensen, RDH, Ph.D
October 16, 2015

DSDS/ADA Member
$290.00 - before Oct 3
$315.00 - after Oct 3
NonADA Member
$390.00 - before Oct 3
$415.00 - after Oct 3
Staff/Student/Resident/Spouse
$150.00 - before Oct 3
$175.00 - after Oct 3


TOTAL REGISTRATION $0

 
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