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:

2017
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/Spouse
$175.00 - before Oct 27
$195.00 - after Oct 27		 Resident
$0.00 - before Oct 27
$0.00 - after Oct 27
2018
January 1, 2018
2018 Five Program Package - One Dentist & One Staff Person
DSDS/ADA Member - $1400.00 NonADA Member - $1875.00 Staff/Student/Spouse - $0.00 Resident - $0.00
February 2, 2018
Annual OSHA Traning & Infection Control Update... Are You Safe Enough - Nancy Dewhirst, RDH, BS
DSDS/ADA Member
$315.00 - before Jan 19
$335.00 - after Jan 19		 NonADA Member
$415.00 - before Jan 19
$435.00 - after Jan 19		 Staff/Student/Spouse
$175.00 - before Jan 19
$195.00 - after Jan 19		 Resident
$0.00 - before Jan 19
$0.00 - after Jan 19
March 23, 2018
Treatment Planning, Designing & Delivering Complex Restorative & Multidisciplinary Cases - Marc Geissberger, DDS
DSDS/ADA Member
$315.00 - before Mar 9
$335.00 - after Mar 9		 NonADA Member
$415.00 - before Mar 9
$435.00 - after Mar 9		 Staff/Student/Spouse
$175.00 - before Mar 9
$195.00 - after Mar 9		 Resident
$0.00 - before Mar 9
$0.00 - after Mar 9
September 21, 2018
Creating a Cosmetic Practice Within Your General Practice - Gary Radz, DDS
DSDS/ADA Member
$315.00 - before Sep 7
$335.00 - after Sep 7		 NonADA Member
$415.00 - before Sep 7
$435.00 - after Sep 7		 Staff/Student/Spouse
$175.00 - before Sep 7
$195.00 - after Sep 7		 Resident
$0.00 - before Sep 7
$0.00 - after Sep 7
October 12, 2018
The Top 10 Secrets to Make Your Practice Thrive - Kirk Behrendt
DSDS/ADA Member
$315.00 - before Sep 28
$335.00 - after Sep 28		 NonADA Member
$415.00 - before Sep 28
$435.00 - after Sep 28		 Staff/Student/Spouse
$175.00 - before Sep 28
$195.00 - after Sep 28		 Resident
$0.00 - before Sep 28
$0.00 - after Sep 28
November 9, 2018
I Have It... You Need It! Must Have Products & Materials - Howard Glazer, DDS
DSDS/ADA Member
$315.00 - before Oct 26
$335.00 - after Oct 26		 NonADA Member
$415.00 - before Oct 26
$435.00 - after Oct 26		 Staff/Student/Spouse
$175.00 - before Oct 26
$195.00 - after Oct 26		 Resident
$0.00 - before Oct 26
$0.00 - after Oct 26

TOTAL REGISTRATION $0

 
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Delaware State Dental Society
892 Eichele Road
Perkiomenville, PA 18074-9510
Phone: 302-368-7634
Email:
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