2019 Continuing 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 download the Registration Form PDF, fill it out and mail it to us. We cannot accept an online registration for checks. Thank you.

Mail: DSDS, 892 Eichele Road, Perkiomenville, PA 18074

Name:
Title:
Employer's Name:
(Staff registrants only)
Office Address:
City:
State:
Zip Code:
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:

2019 Five Program Package - One Dentist
DSDS/ADA Member - $1100.00 NonADA Member - $1475.00
February 1, 2019
Dental Insurance Reimbursement & New Codes - Tom Limoli, Jr.
DSDS/ADA Member
$315.00 - before Jan. 18
$335.00 - after Jan. 18		 NonADA Member
$415.00 - before Jan. 18
$435.00 - after Jan. 18		 Staff/Student/Spouse
$175.00 - before Jan. 18
$195.00 - after Jan. 18
March 29, 2019
Functional Considerations in Esthetic Dentistry - Thomas McDonald, DMD
DSDS/ADA Member
$315.00 - before Mar. 15
$335.00 - after Mar. 15		 NonADA Member
$415.00 - before Mar. 15
$435.00 - after Mar. 15		 Staff/Student/Spouse
$175.00 - before Mar. 15
$195.00 - after Mar. 15
September 27, 2019
Introduction to Dental Sleep Medicine for the General Dental Team & Practical Dental Sleep Medic - Steve Carstensen, DDS
DSDS/ADA Member
$315.00 - before Sep. 13
$335.00 - after Sep. 13		 NonADA Member
$415.00 - before Sep. 13
$435.00 - after Sep. 13		 Staff/Student/Spouse
$175.00 - before Sep. 13
$195.00 - after Sep. 13
October 25, 2019
Prep N' Produce: A Comprehensive Guide to Prep Design, Indirect Material Selection and the Glues We - Timothy Bizga, DDS
DSDS/ADA Member
$315.00 - before Oct. 11
$335.00 - after Oct. 11		 NonADA Member
$415.00 - before Oct. 11
$435.00 - after Oct. 11		 Staff/Student/Spouse
$175.00 - before Oct. 11
$195.00 - after Oct. 11
November 22, 2019
The Wallectectomy - Embezzlement in the Dental Practice - Pat Little, DDS (PM Lecture)
(Lunch included with PM course)
DSDS/ADA Member
$155.00 - before Nov 8
$165.00 - after Nov 8		 NonADA Member
$205.00 - before Nov 8
$215.00 - after Nov 8		 Spouse Only
$90.00

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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