This program is sponsored by the Philadelphia County Dental Society in cooperation with an Engagement Grant from the American Dental Association. The ADA requires that all of the information below be completed by program participants. Incomplete forms will not be processed for registration.
*New Dentists are defined by ADA as dentists who have graduated within the last 10 years
Use a SEPARATE reservation form for each person.
I am a CURRENT MEMBER OF:
I am NOT CURRENTLY AN ADA MEMBER
Dental School & Year of Graduation:
I have a current Pennsylvania dental license:
I have a current dental license in the following state(s):
I currently practice/plan to practice in:
You may submit up to 2 questions you would like the speaker(s) to address:
DAVE & BUSTER'S
325 NORTH COLUMBUS BLVD., PHILADELPHIA, PA 19106
REGISTRATION INCLUDES REFRESHMENTS & FREE PARKING (Parking is $15.00 prepaid as you enter. Bring your receipt to the session. We will arrange to reimburse your credit card.)
The Philadelphia County Dental Society neither expresses nor implies that specific courses will fulfill various state continuing education requirements.Consult the regulations pertaining to the requirements of your state.
General Information, Questions, Comments: firstname.lastname@example.org
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