APDA REGISTRATION FORM
Alliance of the Pennsylvania Dental Association
Partnering to promote oral health in the community
The Alliance of the Pennsylvania Dental Association ( APDA ) welcomes all dental spouses into membership to support oral health education and legislative involvement .
APDA Registration Form
63 R D ANNUAL MEETING
Friday , April 26
APDA Registration APDA Member Luncheon Honoring APDA Past Presidents APDA Social Event Wine and Chocolate Pairings
10:30 AM 11:30 AM
1:30 PM
2013 APDA Convention
REGISTRATION FORM
Registration Deadline March 18 , 2013 Make Checks Payable to APDA and mail with completed registration to Stephanie Test at 888 Kingswood Lane , Danielsville , PA 18038
Questions ? Contact Stephanie at ( 610 ) 462-1109
Saturday , April 27
ADPA Registration APDA Board Meeting
9:00 AM 9:15 AM
NAME
2013 APDA Membership Project – MOM-n-PA on May 31-June 1 , 2013
APDA members will be volunteers at two-day free dental clinic in Philadelphia for underserved Pennsylvanians . We are requesting a small monetary donation from all attendees to help with the expenses of this dental clinic . Make your check payable to MOM-n- PA and drop it off at the APDA registration table or see any Alliance member . Thank you for your support .
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COMPONENT
ADDRESS
CITY
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STATE |
ZIP |
PHONE |
CELL |
|
SPOUSE ’ S NAME
Event |
Cost |
# Attending |
Total |
APDA Member Luncheon |
$ 45 |
X _____ |
= __________ |
APDA Friday Social Event |
$ 45 |
X _____ |
= __________ |
J A N / F E B 2 0 1 3 | P E N N S Y LVA N I A D E N TA L J O U R N A L 1 7