North Dakota Dental Assistants Association 2026 Annual State Convention Registration

North Dakota Dental Assistants Association 2026 Annual State Convention Registration

Friday September 18, 2026 at The Radisson in Bismarck
Full Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employer (if applicable)
Which Registration do you hold in ND?
ADAA Number
ND Registration Number
How many are staying for lunch? This years lunch is sponsored by Patterson Dental
Do you have a food allergy, If so please list below

NON MEMBER ASSISTANT or HYGIENIST

Early Bird until Tuesday September 1, 2026 then price is $150

$150.00 Quantity

ND ADAA MEMBER

Early Bird until Tuesday September 1, 2026 then price is $75

$75.00 Quantity

Total

Late Fee/Refund Policy: Due date is September 1, 2026, after September 5, 2026 late fee registration will be an additional $25.00. After September 12th, lunch will no longer be an option. Before September 5 no fee for cancellation, after September 5th there will be a cancellation fee of $25.00.

NO refunds for NO SHOWS
Should be Empty: