2024 Summer Meeting Registration

2024 Summer Meeting Registration

August 9-10, 2024 Hilton Orlando
Please complete registration form below.

Paying by check? Payable to: FAP

Mail to:

FAP, 30524 Birdhouse Drive, Wesley Chapel, FL 33545

Paying by VISA, MC, Discover, or American Express - payment info below.

Thank you.

LATE REGISTRATION FEES/ONSITE FEES: ALL FEES WILL INCREASE BY $50.00 BEGINNING AUGUST 1. FEES BELOW REFLECT LATE REGISTRATION FEES.
Name*

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Phone Number*
Please enter a valid phone number.
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example@example.com
I am: (Hand-On Workshop is not included in below fees)*

A current FAP Member - $50.00 for Sat. lecture, lunch, receptionA retired FAP Member - $100.00 fee for Sat. lecture, lunch, receptionI am not a member of the FAP - $400.00 fee for Sat. lecture, lunch, receptionReferring Dentist - $250.00 fee for Sat. lecture, lunch, receptionI am a perio resident or a dental student - $100.00 for Sat. lecture, lunch, reception
I am going to:*

Hands-On Workshop - Friday 1:00PM-5:00PM - $635.00 SOLD OUT - WAITLISTWelcome Reception on Friday 5:00PM-6:30PMSaturday Lecture (Drs. Fien & Puterman) starting at 9:00AMBusiness Meeting/Luncheon (only those selecting will receive a lunch ticket)
I am attending the luncheon and need a vegetarian plate.

Yes
I want to also register:

Dental Team Members for Saturday Lecture (lunch on their own) $50.00 eachReferring Dentist(s) $250.00 each (non-periodontists)
Names of dental team members and designation, i.e., RDH and/or referring dentists:

My Products

Hands-On WorkshopSold out - contact FAP office

$635.00 Quantity

Referring Dentist

$250.00 Quantity

Dental Team Member(s)

$50.00 Quantity

Non-FAP Member

$400.00 Quantity

Retired FAP Member

$100.00 Quantity

FAP Member

$50.00 Quantity

Dental Resident/Student

$100.00 Quantity

Total

$0.00

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Street Address

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