2025 PFA Leadership Conference and Convocation Registration Form

2025 PFA Leadership Conference and Convocation Registration Form
MUST READ INFORMATION!

(Terms and Conditions)
Please note that registration for the 2025 Annual Convocation and Awards Ceremony is REQUIRED to receive the Pierre Fauchard Academy hotel room rate at the Ritz Carlton Resort, Reynolds Plantation for January 24,25, and 26. Submitting this form does NOT register you for a room. Please use the link available after submission of your registration or call the resort directly at (844) 205-7371 group ID: Pierre Fauchard Academy. Reserve your room for January 24,25 and 26 by January 2, 2025 to receive the special group rate of $219. No resort fee will be charged for our group at checkout. The special rate is also available for Thursday January 23 ONLY for registrants who participate in the Give Kids a Smile event Friday morning. To book a room for Thursday, January 23 please register for the event AND send an email request to info@northcobbendo.com. Your registration fee (see below) covers these PFA Georgia events and meals for members and/or spouses/guests: Friday Welcome Reception, Saturday lunch with vendors and CE course, Saturday night black tie convocation dinner with entertainment, and Sunday breakfast meeting and CE presentation. All other meals, hotel room costs, taxes, gratuities, and resort activity fees are the responsibility of the registrant. Watch your e-mail as meeting dates approach for further details of our 22nd Annual Conference (January 24-26, 2025). To register for the meeting, complete this form and pay online in the section below OR register online and send a check to: PFA Georgia Section, c/o Dr. Karyn Stockwell, 3900 Frey Road, Ste. 100, GA 30144 (made payable to PFA Georgia Section). Registration fee refunds will be issued without penalty for written cancellations received on or before January 10, 2025. Refunds cannot be issued after that date.
State of PFA Membership
Member/Inductee Name*

First NameLast Name
Saturday afternoonSunday morning
12I do not plan to attend
Spouse/Guest Name attending the conference

First NameLast Name
Email*
example@example.com
Meeting and Activities Registration

PLEASE NOTE: ALL hotel reservations MUST accompany valid meeting registration(s) to be eligible for the special PFA group rate.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Phone Number for correspondence*
Please enter a valid phone number.Format: (000) 000-0000.
***Come and enjoy the NEWLY RENOVATED SPA!***

All spa services are being offered at 15% off to our members during the meeting. Please call the Ritz Carlton Spa directly at (706) 467-7185 as soon as possible as availability is limited and mention you are an attendee of the PFA dental meeting to receive your discount.

Registration Options:

REMINDER:

Submitting this form does NOT register you for a room. Please use the BLUE link available after submission of your registration or call the Ritz Carlton Resort directly at (844) 205-7371, group ID: Pierre Fauchard Academy. The special PFA Georgia room rate of $219 per night plus taxes will depend on the availability at the resort. No resort fee will be charged for our group at checkout. Refunds for the meeting registration fee will be issued without penalty for written cancellations received on or before January 10, 2024. Refunds CANNOT be issued after that date.
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2025 PFA Leadership Conference and Convocation Registration Form

MUST READ INFORMATION!

Meeting and Activities Registration