REGISTRATION FORM Pennsylvania ’ s Dental Meeting | April 25-26 , 2025
REGISTRATION FORM Pennsylvania ’ s Dental Meeting | April 25-26 , 2025
( one form per person , please )
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 ADA Member Dentist m Non-Member Dentist m Dental Hygienist m Dental Assistant
m Non-Licensed Office Staff m Dental Student / Resident Please provide the name of the dental school / residency program that you are currently enrolled in :
___________________________________________
Spouses and guests NOT attending courses will need a name badge . Please list additional attendees :
FULL NAME NICKNAME
FULL NAME NICKNAME
ACTIVITIES
The registration fees for activities are in addition to the Full Day and Half Day registration fees .
Sponsor a Dental Student Help underwrite the cost PDA pays to host a dental student at the meeting .
m $ 75 per student x _______ = _______
Thursday , April 24 , 2025 , 6:00 p . m . – 7:30 p . m . Meet Your PDA Leaders Reception – open to all PDA members and their guests . Join your reception hosts , PDA president , Cary Limberakis and PDA president-elect , Ted Rockwell for drinks and dialog . Dress code is casual .
No charge per attendee but please indicate how many will attend the event _______
Thursday , April 24 , 2025 , 7:45 p . m . – 9:30 p . m . Axe Throwing – ($ 38 per person ) – it ’ s a short trip across the street from the hotel to Splitting Edge to try your hand at axe throwing . Instruction is provided along with beverages and snacks . Dress code is casual and flannel is encouraged !
m $ 38 per attendee x _______ = _______
Friday , April 25 , 2025 , 9:30 a . m . – 11:00 a . m . or 1:45 p . m . – 3:15 p . m . Cookie Decorating with Bunny Lyons – ($ 75 per person ) you ’ ll decorate three dental themed cookies guided by expert baker and decorator , Bunny Lyons , who has appeared on Food Network ’ s Christmas Cookie Challenge . All materials are provided . Just bring your creativity and prepare to have fun ! Dress code is casual .
m 9:30 a . m . Session $ 75 per attendee x _______ = _______ m 1:45 p . m . Session $ 75 per attendee x _______ = _______
Friday , April 25 , 2025 , 6:00 p . m . – 7:00 p . m . Welcome Reception – ($ 40 per person ) – mingle with friends and colleagues before dinner . Open to all members and their guests ; not just member dentists attending the meeting . Dress code is business attire .
m $ 40 per attendee x _______ = _______
Friday , April 25 , 2025 , 7:00 p . m . – 10:00 p . m . Member ’ s Celebration and Awards Dinner ($ 80 per person ) – open to all PDA members and their guests . The dinner will recognize those making an impact on our profession , including PDA ’ s outgoing president , Dr . Cary John Limberakis ; PDA board members who have completed their term of service and the 2025 winners of PDA ’ s Distinguished Service , Recognition and Public Service awards . Dress code is business attire .
m $ 80 per attendee x _______ = _______
Saturday , April 25 , 2025 , 4:45 p . m . – 5:45 p . m . Reception ($ 20 per person ) – Open to members of the Pierre Fauchard Academy ; the Philadelphia-Delaware Valley Section of the American College of Dentists and the International College of Dentists , USA Section , District 3 and their guests . Dress code is business casual .
m $ 20 per attendee x _______ = _______
JANUARY / FEBRUARY 2025 | PENNSYLVANIA DENTAL JOURNAL 27