General Membership Meeting Registration Form
Wednesday, November 5, 2025

Register for the DSDS Business Meeting, and/or place dinner reservations, by November 3.

Please complete the information below to register.
No refunds can be offered.

There is a charge of $60/person to attend the Buffet Dinner. Payments may be made by credit card using the registration form below. If you wish to pay by check or purchase order, please download, print and complete the Registration Form PDF, and return it via email or mail. Checks should be made payable to DSDS and mailed to the address below. If using a check, also email DSDSTOM@comcast.net to be placed on the attendance list.

Mail: DSDS, 29 Trailwood Drive, Fountain Inn, SC 29644

Email: DSDSTOM@comcast.net

Name:
Title:
Membership Type:
Employer's Name:
(Staff registrants only)
Office Address:
City:
State:
Zip Code:
Office Phone:
Emergency Phone:
Email:
(Registration Confirmation will be sent via Email approximately one week prior to the course.)

REGISTRATION FEE:

Other Attendees:

TOTAL REGISTRATION $0.00

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