2025 NDDAA ANNUAL CONVENTION

North Dakota Dental Assistants Association 2025 Annual State Convention Registration

September 19 at The Delta Hotel, Fargo ND
Name*

First NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Mobile Number*
Office Name*
Which Registration do you hold in ND*
ADAA NUMBER
ND REGISTRATION NUMBER*
If registering for an entire office, please write first and last names with Registarion Number and if they are staying for lunch. If not answered, will not be counted for lunch. ****Please also pick the appropriate number of people at check out or NO entry into the event for the office.******
Are you staying for lunch? This years lunch is sponsored by Patterson Dental*

I am NOT a member of America Dental Assistant Association NON MEMBER

$125.00 Quantity

I AM a member of the American Dental Assistant Association Discounted member rate and all ADAA numbers provided and will be verified

$65.00 Quantity
Item subtotal:$0.00

Total

$0.00

REFUND/LATE FEE POLICY:

Due date is September 1, 2025, after September 5, 2025 late fee registration will be $25.00. After September 12th no longer have the option for lunch, Before September 5th no fee to cancellation, after September 5, there will be a cancellation Fee of $25.00. Refunds will not be granted for no-show.
Should be Empty:

North Dakota Dental Assistants Association 2025 Annual State Convention Registration