Registration Form

Registration Form

This form can be filled out and submitted electronically through the "Submit" button below, or emailed to studyclub@charlotteperio.com
Date*

MonthDayYear
Practice Name*
Hygienist Name(s), Email(s)* & Phone Number(s)*
*Correspondence and notification of meetings are sent via email.

Dues for 2025 are $165/person.

Make checks payable to “Charlotte Dental Hygiene Study Club” and include this form with your check.

To pay by credit card, please call our office at (704) 365-0123.

Mailing Address:
CharlottePerio, ATTN: Study Club
3535 Randolph Road, Suite 103-R
Charlotte, NC 28211

If you have any questions or concerns, please call or text 704-931-8919. We look forward to having you as part of the study club in 2025!

Amy Woodcock, RDH
Education Coordinator
CharlottePerio
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