2022 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 or fax it to us. We cannot accept an online registration for checks. Thank you.

Fax: 215-234-9936
Mail: DSDS, 2803 Philadelphia Pike, B #4083, Claymont, DE 19703

Name:
Title:
(as it should appear on your tag...DR., MR., MRS., MS.)
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:

September 30, 2022
Dental Insurance Reimbursement: My Paycheck Depends on It - AND - Simplify Reimbursement with More New Codes? Are You Kidding? - Mr. Tom Limoli
FULL DAY IN-PERSON - 8:30 AM - 4:00 PM
DSDS/ADA Member
$315.00 - before Sep. 16
$335.00 - after Sep. 16
NonADA Member
$415.00 - before Sep. 16
$435.00 - after Sep. 16
Staff/Student/Spouse
$175.00 - before Sep. 16
$195.00 - after Sep. 16
November 4, 2022
The Time is Now… Success and Profit with Digital Impressions and CAD/CAM Restorations - Jack D. Griffin, Jr., DMD
FULL DAY IN-PERSON - 8:30 AM - 4:00 PM
DSDS/ADA Member
$315.00 - before Oct. 21
$335.00 - after Oct. 21
NonADA Member
$415.00 - before Oct. 21
$435.00 - after Oct. 21
Staff/Student/Spouse
$175.00 - before Oct. 21
$195.00 - after Oct. 21


TOTAL REGISTRATION $0

 
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Delaware State Dental Society
2803 Philadelphia Pike
B #4083
Claymont, Delaware 19703
Phone: 302-368-7634
Email: