Convention Registration Form

YOUR PERSONAL INFO

Practice name is required
First name is required
Last name is required
Email 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 ($160)
ADA is required
Full name is required
Email is required
OUT-OF-STATE ADA MEMBER DENTIST NAME ($265)
ADA is required
Full name is required
Email is required
NON-UDA/ADA DENTIST NAME ($675)
Full name is required
Email is required
SPOUSE OF DENTIST NAME ($70)
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) ($15)
Full name is required
STAFF DOES NOT NEED TO REGISTER WITH A DENTIST ($80)
Code is required
Full name is required
Email is required
UDA DENTAL HYGIENIST AFFILIATE MEMBER NAME ($70)
Full name is required
ID is required
Email is required
NON-UDA AFFILIATE HYGIENIST NAME ($140)
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 ($0)
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 ($0)
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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