PDM REGISTRATION FORM
PDA/ADA
Member Dentists
Select Courses
Non-Member Dentists Hygienists, Assistants,
Non-Licensed Staff
and Guests
By 3/23 After 3/23 By 3/23 After 3/23
By 3/23
After 3/23
Friday, April 27
Infection Control (2 CE credits) @ 8:00 a.m. m $65 m $90 m $165 m $230
m $65
m 90
Friday, April 27
Clinical Records @ 8:30 a.m. (3 CE credits) m $150 m $210 m $250 m $350
m $95
m $130
Friday, April 27
Act 31 CE @ 10:00 a.m. (2 hours of CE) m $50 m $70 m $150 m $210
m $50
m $70
Friday, April 27
Anesthesia @ 12:30 p.m. (4 CE credits)
Special Pricing for Anesthesia Permit Holders m $200
m $175 m $280
m $245 m $300
m $275 m $420
Not Available
Not Available
m $385
Not Available
Not Available
Friday, April 27
Act 124 CE @ 1:00 p.m. (4 CE credits) m $200 m $280 m $300 m $420
m $130
m $180
Saturday, April 28
Strategies for Increasing Production
@ 8:00 a.m. (6 CE credits) m $250 m $350 m $350 m $490
m $160
m $225
PDA Legislative Update @ 3:15 p.m. on April 28 m $0 m $0
Not Available
Not Available
m $0
m $0
PDA Business Meeting @ 4:00 p.m. on April 28 m $0 m $0
Not Available
Not Available
m $0
m $0
Total Due $ ______________________________________________________
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
EXP. DATE
Registrations accepted until April 5, 2018. Cancellations must be received
in writing by April 10, 2018. 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.
SIGNATURE
PRINT NAME AS IT APPEARS ON THE CARD
N OVEM BER/DECEM BER 2017 | P EN N SYLVAN IA DEN TAL JOURNAL
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