2021 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:

February 10, 2021
Top Clinical Tips for Esthetic Success - Lee Ann Brady, DMD
WEBINAR – 7:00 PM – 9:00 PM
Course Cost: $75
March 31, 2021
Controlled Substance - David W. Dryden, JD, RPh
WEBINAR – 7:00 PM – 9:00 PM
Course Cost: $50
September 24, 2021
Introducing Lasers in Managing Periodontal/Soft Tissue Conditions - Samuel Low, DDS
DSDS/ADA Member
$315.00 - before Sep. 10
$335.00 - after Sep. 10		 NonADA Member
$415.00 - before Sep. 10
$435.00 - after Sep. 10		 Staff/Student/Spouse
$175.00 - before Sep. 10
$195.00 - after Sep. 10
October 22, 2021
Distinguishing the Benign from the Deadly: Oral Pathology Update - Susan Muller, DMD
DSDS/ADA Member
$315.00 - before Oct. 8
$335.00 - after Oct. 8		 NonADA Member
$415.00 - before Oct. 8
$435.00 - after Oct. 8		 Staff/Student/Spouse
$175.00 - before Oct. 8
$195.00 - after Oct. 8
November 19, 2021
Product Review - Howard Glazer, DDS
DSDS/ADA Member
$315.00 - before Nov. 5
$335.00 - after Nov. 5		 NonADA Member
$415.00 - before Nov. 5
$435.00 - after Nov. 5		 Staff/Student/Spouse
$175.00 - before Nov. 5
$195.00 - after Nov. 5

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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