2025 Summer Meeting Registration Form

2025 Summer Meeting Registration Form

August 8-9, 2025 Wyndham Grand Orlando Resort Bonnet Creek
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please select all appropriate registration categories. Airway Management and Hands-On Workshop require additional registration fees.*
prevnext( X )
FAP Member (active, life, retired)
$100.00 Quantity



Periodontist, Not an FAP Member
$350.00 Quantity



Referring Dentist (GP/non-specialist)
$200.00 Quantity



Perio Resident/Dental Student
$50.00 Quantity



ADDITONAL REGISTRATION: Airway Management - Dentists
$525.00 Quantity



ADDITIONAL REGISTRATION: Airway Management - Dental Team Members
$250.00 Quantity



ADDITIONAL REGISTRATION: Hands on Workshop-Dentists (includes 1 team member)
$100.00 Quantity



ADDITIONAL REGISTRATION: Hands-on Workshop-Additional Team Members Fri reception, Sat Lecture, Sat Hands - on
$50.00 Quantity



Total

$0.00
Names of Dental Team Members and/or Referring Dentists
Please indicate below dental team member name or referring dentist and what they will be attending. If you need more to add more information, contact the FAP office. Thank you.

Examples:

Linda Smith, RDH Airway Only

Jane Williams, Surgical Asst. - Saturday Lecture/HOW

Dr. John Smith, Referring Dentist, Airway, Friday/Saturday Lectures
Name/Attending
Name/Attending
Name/Attending
Name/Attending
Name/Attending
Dentists: I am attending the luncheon/business meeting on Saturday.*

Yes, include me in your lunch count.Yes/Need vegetarian option.No, I will not be attending.
Dentists: I am attending:*

Friday Dr. Miron LectureSaturday Dr. Miron LectureSaturday HOW w/team members
Other Information

Please email or telephone the FAP with any additional team member names, fap@tampabay.rr.com 352-232-6800 or with questions.

Friday - Lunch is on your own.

Saturday - Dentists attend the business meeting/luncheon (see above). Only those indicating they will attend the luncheon/business meeting will receive a ticket.

Dental Team Members lunch on their own.

Paying by credit card? Use the link below. After putting in you credit card via the link and submitting, close out that page, and return to this form and submit.

Want to pay by check? Remit to: FAP and mail: 30524 Birdhouse Drive, Wesley Chapel, FL 33545.
CLICK HERE TO SUBMIT CREDIT CARD PAYMENT.

Close out payment window when credit card transaction is complete and return to this form to sign and submit.

Thank you.
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2025 Summer Meeting Registration Form

Names of Dental Team Members and/or Referring Dentists