ENTAL MEETING
REGISTRATION FORM ( one form per person , please ) Pennsylvania ’ s Dental Meeting | April 29-30 , 2022
FULL NAME : NICKNAME ( FOR BADGE ):
ADDRESS : CITY : STATE : ZIP :
PHONE : EMAIL :
DESCRIBE ANY DIETARY ALLERGIES OR ACCESSIBILITY NEEDS :
Please check one : m PDA Member Dentist m Dental Hygienist
Spouses and guests NOT attending courses will need a name badge . Please list additional attendees :
m ADA Member Dentist |
m Dental Assistant |
FULL NAME |
NICKNAME |
m Non-Member Dentist |
m Non-Licensed Office Staff |
FULL NAME |
NICKNAME |
SOCIAL EVENTS
Dental Student Funding Help underwrite the cost PDA pays to host a dental student at the meeting .
m $ 75 per student x _______ = _______
Welcome Reception – mix & mingle with friends and colleagues from across the Commonwealth . Open to all members and their guests ; not just member dentists attending the meeting .
Dress code is business casual . Friday , April 29 , 2022 , 6:00 p . m . – 7:00 p . m . m $ 30 per attendee x _______ = _______
Board of Trustees ’ Dinner & Awards – join us for a dinner honoring those making an impact on our profession . Honorees include PDA ’ s outgoing president ; presidents who completed their term in 2020 and 2021 and the recipients of PDA ’ s Annual Awards from 2020 , 2021 and 2022 . Open to all members and their guests ; not just member dentists attending the meeting .
Dress code is business attire . Friday , April 29 , 2022 , 7:15 p . m . – 10:00 p . m . m $ 80 per attendee x _______ = _______
JANUARY / FEBRUARY 2022 | PENNSYLVANIA DENTAL JOURNAL 33