2017 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:

September 22, 2017
Avoid Liability: Know Your Patients' Medications and Their Impact on Dental Treatment - Harold L. Crossley, DDS
DSDS/ADA Member
$315.00 - before Sep 8
$335.00 - after Sep 8
NonADA Member
$415.00 - before Sep 8
$435.00 - after Sep 8
Staff/Student/Resident/Spouse
$175.00 - before Sep 8
$195.00 - after Sep 8
October 13, 2017
Seeking Interdisciplinary Excellence - Frank Celenza, DDS
DSDS/ADA Member
$315.00 - before Sep 29
$335.00 - after Sep 29
NonADA Member
$415.00 - before Sep 29
$435.00 - after Sep 29
Staff/Student/Resident/Spouse
$175.00 - before Sep 29
$195.00 - after Sep 29
November 10, 2017
Life is Your Best Medicine - Tieraona Low Dog, MD
DSDS/ADA Member
$315.00 - before Oct 27
$335.00 - after Oct 27
NonADA Member
$415.00 - before Oct 27
$435.00 - after Oct 27
Staff/Student/Resident/Spouse
$175.00 - before Oct 27
$195.00 - after Oct 27


TOTAL REGISTRATION $0

 
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Christiana Executive Campus
200 Continental Drive
Suite 111
Newark, Delaware 19713
Phone: 302-368-7634
Fax: 302-368-7669
Email: