2025 WM Reg Form Revised

2025 Winter Meeting Registration

February 7-8, 2025 - Wyndham Grand Orlando Resort Bonnet Creek
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
I am:*

A current FAP Active Member - $100.00 for lectures, lunch, receptionAn FAP Retired Member - $100.00 for lectures, lunch, receptionI am not a member of the FAP - $350.00 for lectures, lunch, receptionReferring Dentists - $200.00 for lectures, lunch receptionI am a perio resident or dental student - $50.00 for lectures, lunch, receptionI am a 3RD YEAR UF/NSU RESIDENT and will be presenting on Friday - NO FEE
I am going to:*

Residents' Presentations - Friday, Feb. 7, 2PM-5:30PMWelcome Reception - Friday, Feb 7, 5:30PM-7PMSaturday Lecture - Saturday, Feb. 8, 9AM - Dr. Michael NortonBusiness Meeting/Luncheon- Sat.(only those selecting this will receive a lunch ticket)
I am attending the luncheon and request a vegetarian plate:

Yes
I want to also register:

Dental Team Members for Saturday Lecture (lunch on their own) $50.00 eachReferring Dentist(s) $200.00 each - non-periodontists
Names of dental team members and their designation, i.e., RDH and/or referring dentists:
PAYMENT INFORMATION

If paying by check:

FAP

30524 Birdhouse Drive, Wesley Chapel, FL 33545

If paying by credit card (Visa/MC/Discover/American Express):

Important - After submitting credit card payment by clicking payment link, you must return to the registration form and click the green submit button located below "Payment Link" - this will officially register you.

Payment Link
Should be Empty:

2025 Winter Meeting Registration