PDM REGISTRATION FORM
Select Sessions
PDA / ADA Member Dentists
Non-Member Dentists
Hygienists , Assistants , Non-Licensed Staff and Guests
By 3 / 31 After 3 / 31 By 3 / 31 After 3 / 31 By 3 / 31 After 3 / 31
Friday , April 29 – 4:45 p . m . |
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Council of Districts ’ Meeting |
m $ 0 |
m $ 0 |
Not Available |
Not Available |
Not Available |
Not Available |
Open to appointed representatives |
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Saturday April 30 – 7:15 a . m . Chair Yoga ( Limited Attendance ) m $ 0 m $ 0 Not Available Not Available Not Available Not Available
Saturday , April 30 – 8:00 a . m . Current Materials ( 3 CE credits )
m $ 135 |
m $ 175 |
m $ 100 |
m $ 130 |
retired , life or volunteer license holder |
m $ 235 m $ 305 m $ 90 m $ 115
Saturday , April 30 – 8:30 a . m . Business of Dentistry m $ 0 m $ 0 m $ 0 m $ 0 m $ 0 m $ 0
Saturday , April 30 – 11:00 a . m . Dental Technologies ( 1.5 CE credits )
m $ 55 |
m $ 70 |
m $ 41 |
m $ 53 |
retired , life or volunteer license holder |
m $ 155 m $ 200 m $ 55 m $ 70
Saturday , April 30 – 11:45 a . m . |
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Tickets for Lunch |
m $ 38 |
m $ 38 |
m $ 38 |
m $ 38 |
m $ 38 |
m $ 38 |
( NOTE : lunch is not included with any courses ) |
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Saturday , April 30 – 1:00 p . m . Worn Dentition ( 3 CE credits )
m $ 135 |
m $ 175 |
m $ 100 |
m $ 130 |
retired , life or volunteer license holder |
m $ 235 m $ 305 m $ 90 m $ 115
Saturday , April 30 – 1:45 p . m . PDA Business Meeting |
m $ 0 in-person m $ 0 virtual |
m $ 0 in-person m $ 0 virtual |
Not Available Not Available m $ 0 m $ 0 |
Saturday , April 30 – 8:00 a . m . - 5:00 p . m . Virtual Package
m $ 230 |
m $ 230 |
m $ 200 |
m $ 200 |
retired , life or volunteer license holder |
m $ 330 m $ 330 m $ 165 m $ 165
Method of Payment
Please make check payable to : PDA and mail with completed form to P . O . Box 3341 , Harrisburg , PA 17105 or fax your registration to ( 717 ) 232-7169 or register online at www . padental . org / PDM
m Check m MasterCard m Visa m American Express m Discover
CARD NUMBER
SIGNATURE
EXP . DATE
Total Due $_____________________________________________
Registrations accepted until April 22 , 2022 . Cancellations must be received in writing by April 25 , 2022 . No refunds will be issued for registrations cancelled after April 25 . Cancellations can be faxed to ( 717 ) 232-7169 or emailed to rvn @ padental . org .
Questions ?
Contact Rebecca Von Nieda at ( 717 ) 234-5941 , ext . 117 or rvn @ padental . org .
PRINT NAME AS IT APPEARS ON THE CARD
34 JANUARY / FEBRUARY 2022 | PENNSYLVANIA DENTAL JOURNAL