FDAA 2026 Event: "Amplify Your Impact!" Group Registration Form
Directions: Once your group registration has been paid, please fill out the details below to register the individual names for your group. Be sure to list each name as it should read on the participant's certificate. Include the group contact name in the master list if they are also attending. Then, have each person registered go to the association website (https://www.fdaausa.org) to choose step 2 and and fill out their form to choose their selection for the box lunch that is included with registration. All lunch choices must be made by midnight, December 31, 2025 otherwise we will choose for the participant.
Group Contact Name
*
First Name
Last Name
Group Contact's Email Address
*
example@example.com
Group Leader's Phone Number
*
Please enter a valid phone number.
Name of person or school/office from which the group payment was made
*
Total Number of Participants in the Group
*
List the full name and role (Student, Educator, Dental Assistant, etc.) for each attendee, separating each name with a comma. Example: Jane Doe (Student), John Smith (Educator), etc.
*
Additional Comments
Register Group
Should be Empty: