PDM Registration Form
PDA/ADA
Member Dentists
Select Courses and Session Times
Hygienists, Assistants,
Non-Licensed Staff
and Guests
By 3/17
By 3/17
By 3/17
Thursday, April 20
Composites @ 3:00 p.m. (3 CE credits)
Special Pricing for New Dentists
m $100
m $49
m $125
m $175
m $215
m $100
m 125
m $49
Not Available
Not Available
Not Available
Not Available
m $250
m $315
m $350
m $435
Not Available
Not Available
m $350
m $435
m $450
m $560
m $250
m $250
Not Available
Not Available
Not Available
Not Available
m $0
m $0
Not Available
Not Available
Not Available
Not Available
m $65
m $80
m $165
m $205
m $65
m $80
m $225
m $280
m $325
m $405
m $175
m $215
m $175
m $215
m $275
m $345
m $175
m $215
m $0
m $0
Not Available
Not Available
Not Available
Not Available
Friday, April 21
Smile Design @ 8:00 a.m. (6 CE credits)
Friday, April 21
Class II Composites Hands-On (3 CE credits)
m 8:30-11:30 a.m. m 1:00-4:00 p.m.
Special Pricing for New Dentists
Friday, April 21
Ask a Lawyer
m 10:30–11:30 a.m. m 11:45 a.m.–12:45 p.m.
m 2:00–3:00 p.m. m 3:15–4:15 p.m.
Friday, April 21
Radiology @ 5:30 p.m. (2 CE credits)
Saturday, April 22
Drug Epidemic @ 8:00 a.m. (5 CE credits)
Saturday, April 22
Oral Cancer @ 8:00 a.m. (4 CE credits)
After 3/17
Non-Member Dentists
Saturday, April 22
Dental Trends
m 8:30–9:30 a.m. m 11:30 a.m.–12:30 p.m.
m 2:15–3:15 p.m.
Saturday, April 22
Intranasal 3% Tetracaine plus 0.05% Oxymetazoline
(1 CE credit)
m 10:00–11:00 a.m. m 12:45–1:45 p.m.
m 2:15–3:15 p.m.
m $30
m $40
PDA Legislative Update @ 2:15 p.m. on April 22
m $0
PDA Business Meeting @ 3:00 p.m. on April 22
m $0
Method of Payment
m Check m MasterCard m Visa m American Express m Discover
SIGNATURE
PRINT NAME AS IT APPEARS ON THE CARD
m $85
m $100*
After 3/17
m $125*
* must attend with a doctor
m $30
m $40
m $0
Not Available
Not Available
m $0
m $0
m $0
Not Available
Not Available
m $0
m $0
Total Due $______________________________________________________
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
CARD NUMBER
m $70
After 3/17
EXP. DATE
Registrations accepted until April 5, 2017. Cancellations must be received
in writing by April 10, 2017. No refunds will be issued for registrations
cancelled after April 10. 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.