2020 PENNSYLVANIA’S DENTAL MEETING
REGISTRATION FORM (one form per person, please)
Pennsylvania’s Dental Meeting | April 24-25, 2020
FULL NAME: NICKNAME (FOR BADGE):
ADDRESS: STATE: ZIP:
CITY:
PHONE: EMAIL:
DESCRIBE ANY DIETARY ALLERGIES OR ACCESSIBILITY NEEDS:
Please check one:
m PDA Member Dentist m Dental Hygienist
m ADA Member Dentist m Dental Assistant
m Non-Member Dentist m Non-Licensed
Office Staff
SOCIAL EVENTS
Additional Attendees NOT attending courses or
the exhibit hall will need a name badge. Please list
additional attendees:
FULL NAME NICKNAME
FULL NAME NICKNAME
See Social Events section for more details
Welcome Reception
Network with friends and colleagues
Friday, April 24 – 6:00 p.m.
m $35 per person x _______ = _______
Self-Defense Demo
Open to women ages 10 and older; transportation
is on your own
m $20 per person x _______ = _______
Friday, April 24 – 7:30 p.m.
m $85 per person x _______ = _______ Meet & Greet PDA’s New Executive Director
*a $10 donation will be made to the Pennsylvania
Dental Foundation; member ticket price is subsidized
by PDA and our generous sponsor, the Pennsylvania
Society of Oral and Maxillofacial Surgeons
New Dentist Breakfast
Open to new dentists & dental students Saturday, April 25 – 4:30 p.m.
m $20 per PDA member*
m $35 per guest/spouse
Board of Trustees’ Dinner & Awards Presentation
All are invited to attend this dinner to honor those
making an impact on our profession.
Saturday, April 25 – 7:00 a.m.
m $0
PDA Former Presidents’ Luncheon
Open to member dentists who served as
PDA president Group Reservation at The Grand Buffet
Keep the fun going! Join your friends at the Strouds-
moor Country Inn for an evening of camaraderie and
delicious fare. Shuttle service offered for a fee. Pay on
your own at the restaurant.
Saturday, April 25 – 11:45 a.m.
m $38 per person x _______ = _______ Saturday, April 25 – 7:00 p.m.
Indicate number of people planning to attend ____
Dental Student Funding
Help bring a dental student to the meeting.
m $75 per student x _______ = _______
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NOV E M B E R/DE CE M BER 2019 | P EN N S YLVA N IA D EN TA L J O UR NAL