NYDHA - NYDHA

Name:*

First Name

Last Name

Address:*

AddressCityStateZip

Phone:*

Area Code

Number

E-mail:*

Is this your first conference?

Yes

Registration type:*

Member RDH $150 by Sept. 26, $175 after

Non-Member RDH* $220 by Sept. 26, $255 after

Dental Hygiene Student** $30 by Sept. 26, $50 after

* Not yet a member? Use the member rate if you join now.
** Pre-Registered student professional poster presentation participants are exempt from paying registration fee.

Event Registration Please check the box below for events you will attend.

Conference Registration entitles your entry into Continuing Education Courses, Exhibitors’ Hall on Friday and Saturday, Friday and Sunday morning House of Delegates meetings, Friday morning Candidates’ Forum and Reference Committee Testimony sessions, Student Professional Poster Presentations, Silent Auction, and Sunday morning House Installation of Officers and Directors.

• Specially ticketed events: Current Issues Luncheon (Course #8) and President’s Reception/Dinner on Saturday are not included in the registration fee. Please see Special Events below to register.*

Special Events:

Saturday, 12-2:30 p.m. Luncheon (Course #8-Current Issues) $45

Saturday, 7:00-10:00 p.m. President’s Reception/Dinner $55

Total Registration and Special Event Fees (please use numbers only, no periods):*

Please note any dietary restrictions:

Please note any disability requirements:

NOTE: When you click on Submit, you will be taken to PayPal to complete your payment securely. You can use your PayPal account, or use your credit or debit card if you don't have a PayPal account. When you are finished with your payment, you will receive a confirmation email.