ANNUAL SESSION OFFICIAL REGISTRATION FORM
Please note that this online form will allow for a maximum of three registrations per transaction. To register additional attendees, please submit the current registration and begin another or call the NCDHA office at 336-975-0029 for further assistance.
*Note: If paying with a credit card, you MUST select the checkbox and member type that best describes you as the registrant. If this is neglected and your total is $0.00, your registration will be voided and you will not be registered for the Annual Session. Please make sure you have entered all information correctly and check all appropriate boxes.
If submitting credit card payment, please note that this transaction is via Square and will show on your banking statement as "SQ NC" and may be categorized as an Entertainment charge. There may be a variety of listings. If you are suspicious of the statement item, please contact the NCDHA office at (336) 975-0029 to confirm before disputing a charge.
One Friday/Saturday lunch ticket is included in your registration package for the corresponding day(s). The Extra Ticket option is only to purchase additional lunch tickets.
Pre-registration Deadline: Receive by August 31, 2021. No show = No refund! Pre-Registration Deadline: completed form must be received by August 31, 2021 in order to be eligable for meals & breaks. Please allow 10 days for mail delivery. Cancellations cannot be accepted after August 31, 2021. Cancellations received in writing at the NCDHA office prior to August 31, 2021 will receive full refund post meeting, less a 50% processing fee. NCDHA assumes no responsibility other than refunding of registration fees paid if program is cancelled due to any reason that is out of the control of the meeting sponsor. Meals are not guaranteed for on-site registrations. NCDHA is not responsible for any transportation liabilities. Requests for reasonable accommodations as provided by the Americans with Disabilities Act (ADA) must be received in writing in the NCDHA office by August 31, 2021. By registering for this meeting, I understand that my contact information may be provided to the participating exhibitors and my photo could be used in highlights and/or promotional materials.
Upon completion, you will receive a registration confirmation email to the email address provided on the first page.
Please review the information and check for errors. If you have questions, concerns, or changes, you may contact the NC Dental Hygienists' Association office by email at NCDHAsocialmedia@gmail.com or firstname.lastname@example.org or call (336) 975-0029 for further assistance.