TNAGD Annual Meeting 2010

registration form


Registration Options

Cost

AGD Member (or Specialist) Dentist

$545

Non Member Dentist

$600

Dental Assistant  Radiology Course
MUST BE A REGISTERED ASSISTANT TO ATTEND

$450
Dental Assistant Nitrous Oxide Monitoring Course
MUST BE A REGISTERED ASSISTANT TO ATTEND

This fee only covers the course.   Regular registration as a team member is required if attending the DOY and second day Blatchford seminar.

 		$195
Team Members
If you are a RDH, RDA or CDA, please give your license number below for CE purposes

 $185
Extra ticket to Dentist of the Year Gala

 $50
FILL OUT ATTENDEE INFORMATION FOR EACH ATTENDEE! 
GO TO THE BOTTOM OF THE FORM TO SUBMIT TO COMPLETE REGISTRATION. 
YOU WILL BE FORWARDED TO A SHOPPING CART FOR PAYMENT.
Please fill out completely including Doctor's
Office Affiliation and Office Phone Number!


DOCTOR                    Office Phone  

 

Attendee 1: Name


First


M.I.


Last
Email Address

AGD or license number

  

Registration Category

  
                              

Attendee 2: Name


First


M.I.


Last
Email Address

AGD or license number

 

Registration Category

  

 

Attendee 3: Name


First


M.I.


Last
Email Address

AGD or license number

 

Registration Category

  

 

Attendee 4: Name


First


M.I.


Last
Email Address

AGD or license number

 

Registration Category

  

 

Attendee 5: Name


First


M.I.


Last
Email Address

AGD or license number

 

Registration Category

  
                              

Attendee 6: Name


First


M.I.


Last
Email Address

AGD or license number

 

Registration Category

  
               

Attendee 7: Name


First


M.I.


Last
Email Address

AGD or license number

 

Registration Category

  
                 

Attendee 8: Name


First


M.I.


Last
Email Address

AGD or license number

 

Registration Category

  
            

Attendee 9: Name


First


M.I.


Last
Email Address

AGD or license number

 

Registration Category

  
        

Attendee 10: Name


First


M.I.


Last
Email Address

AGD or license number

 

Registration Category