CONVENTION REGISTRATION FORM

  • 1

    Details

  • 2

    Review & Payment

  • 3

    Confirmation

Your Personal Info

  • Sorry no refunds will be made.
  • Staff does not need to register with a dentist.
  • Registration Fees Increase March 5.
  • CE Certificates – Soon after the convention, attendees will receive an email sent to the email address given below. This email will give access to post-session surveys (per course), once each survey is completed, this will allow printing of the CE Certificates. This process will be required to obtain CE certificates.
If you would like to add more than one person to any category please enter the number first to populate the same fields

UDA MEMBER DENTIST NAME ($95)

$
Check

If you would like to join on UDA Membership, please follow the following link: https://www.uda.org/member-center/join-renew/join-renew-now/

OUT-OF-STATE ADA MEMBER DENTIST NAME ($200)

$

NON-UDA/ADA DENTIST NAME ($525)

$

SPOUSE OF DENTIST NAME ($45)

$

FULLY RETIRED DENTIST NAME ($0)

$

SPOUSE OF FULLY RETIRED DENTIST NAME ($0)

$

STUDENT NAME(S) ($5)

$

STAFF DOES NOT NEED TO REGISTER WITH A DENTIST ($50)

Hygienist have to register under Hygienist section.
$

UDA DENTAL HYGIENIST AFFILIATE MEMBER NAME ($25)

$
Check

If you would like to join the UDA Dental Hygienist Affiliate, please use the following link. https://ebusiness.ada.org/productcatalogPo3/100877/UT0006FB5F4SW43/UTeCatalog/UDA-2022-Dental-Hygienist-Affiliate-Membership/

NON-UDA AFFILIATE HYGIENIST NAME ($100)

$

Team Luncheon ($25)

$

Hygienist Luncheon (UDA Affiliate Member) ($25)

$

Hygienist Luncheon (Non UDA Affiliate Member) ($50)

$

Alliance Luncheon(Alliance member) ($25)

$

Alliance Luncheon(Non Member) ($50)

$

  • Workshop - Click Here for Hands On Workshops Registration
    Hands on workshops Count Cost

    CPR CERTIFICATION Thursday 9:00 to 11:00 AM ($35)

    $

    CPR CERTIFICATION Thursday 2:00 to 4:00 PM ($35)

    $

    CPR CERTIFICATION Friday 9:00 to 11:00 AM ($35)

    $

    CPR CERTIFICATION Friday 2:00 to 4:00 PM ($35)

    $

    LIVE LASER Hands-on Workshop 2:00 - 3:15PM ($20)

    $

    LIVE LASER Hands-on Workshop 3:30 - 4:45PM ($20)

    $

Grand Total ($)