Convention Registration Form

YOUR PERSONAL INFO

Practice name is required
First name is required
Last name is required
Email is required
Address is required
City is required
State is required
Zip is required
Notes
  • Sorry, no refunds will be made.
  • Staff can register without a dentist.
  • Name tags will not be mailed this year.  All attendees will need to pick up their name tag at the Convention.
UDA MEMBER DENTIST NAME ($135)
ADA is required
Full name is required
Email is required
OUT-OF-STATE ADA MEMBER DENTIST NAME ($240)
ADA is required
Full name is required
Email is required
NON-UDA/ADA DENTIST NAME ($645)
Full name is required
Email is required
SPOUSE OF DENTIST NAME ($45)
Full name is required
FULLY RETIRED DENTIST NAME ($0)
ADA is required
Full name is required
Email is required
SPOUSE OF FULLY RETIRED DENTIST NAME ($0)
Full name is required
STUDENT NAME(S) ($10)
Full name is required
STAFF DOES NOT NEED TO REGISTER WITH A DENTIST ($55)
Code is required
Full name is required
Email is required
UDA DENTAL HYGIENIST AFFILIATE MEMBER NAME ($45)
Full name is required
ID is required
Email is required
NON-UDA AFFILIATE HYGIENIST NAME ($115)
Full name is required
Email is required
Team Luncheon ($34)
Full name is required
Email is required

Hands on workshops
Count
Cost
CPR CERTIFICATION Thursday 9:00 to 10:30 AM ($50)
Full name is required
ACLS Skills Pass Off Th AM ($150)
Full name is required
Patterson TechEdge Equipment Maintenance Th AM ($40)
Full name is required

Hands on workshops
Count
Cost
CPR CERTIFICATION Thursday 2:00 to 3:30 PM ($50)
Full name is required
ACLS Skills Pass Off Th PM ($150)
Full name is required
Extracting Impacted Third Molars for Beginners ($100)
Full name is required
Patterson TechEdge Equipment Maintenance Th PM ($40)
Full name is required

Hands on workshops
Count
Cost
CPR CERTIFICATION Friday 9:00 to 10:30 AM ($50)
Full name is required
ACLS Skills Pass Off Fr AM ($150)
Full name is required
In-House Clear Aligners: ($400)
Full name is required
Elevate Your Practice: Empowering Dental Assistants ($40)
Full name is required

Hands on workshops
Count
Cost
CPR CERTIFICATION Friday 2:00 to 3:30 PM ($50)
Full name is required
ACLS Skills Pass Off Fr PM ($150)
Full name is required
Integration of Calcium Silicates in the Dental Practice ($100)
Full name is required
3D Printing and Naturalizing Dentures in the Modern Practice ($200)
Full name is required

Grand Total ($)

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