1-2018

PLEASE LIST YOUR GUEST INFORMATION BELOW TO REGISTER FOR THE EVENT.
I AM REGISTERING THE FOLLOWING NUMBER OF BCDA MEMBER AND GUESTS AT $55/PERSON
I AM REGISTERING THE FOLLOWING NUMBER OF NON BCDA MEMBERS AND GUESTS AT $60/PERSON
Total Due
Please remember your payment total as you will need to enter this total when you submit your payment after submitting this registration form.
Please list the names of registrants above. Be sure to include yourself:

PLEASE LIST YOUR GUEST INFORMATION BELOW TO REGISTER FOR THE EVENT ON 1/2018
I am registering the following number of MSDA Members and Guest(s) at $55.00/person
I am registering the following number of NON MSDA Members and Guests at $60.00 per person
Total Due
Please remember your payment total as you will need to enter this total when you submit your payment after submitting this registration form.
Please list the names of registrants above. Be sure to include yourself:

PLEASE LIST YOUR GUEST INFORMATION BELOW TO REGISTER FOR THE EVENT ON 5/2018
I AM REGISTERING THE FOLLOWING NUMBER OF BCDA MEMBERS AND GUESTS AT $55/PERSON
I AM REGISTERING THE FOLLOWING NUMBER OF NON BCDA MEMBERS AND GUESTS AT $60/PERSON
Your Total
Please remember your payment total as you will need to enter this total when you submit your payment after submitting this registration form.
Please list the names of registrants above and be sure to include yourself: Please include a "P" (for Petite Filet) or "C"(for Chicken Chesapeake) to indicate registrant's entree choice

PLEASE LIST YOUR GUEST INFORMATION BELOW TO REGISTER FOR THE EVENT ON 11/16/2018
MEMBER REGISTRATION: EARLY REGISTRATION ENDS 6/29/2018

AFTER 6/29 ALL REGISTRATIONS WILL BE $270 PER DENTIST AND $145 PER STAFF MEMBER
I AM REGISTERING THE FOLLOWING NUMBER OF BCDA MEMBER DENTISTS AT $225/PERSON
I AM REGISTERING THE FOLLOWING NUMBER OF STAFF MEMBERS UNDER MY BCDA MEMBERSHIP AT $115/PERSON
Total Due
Please remember your payment total as you will need to enter this total when you submit your payment after submitting this registration form.
PLEASE LIST THE NAMES OF THE REGISTRANTS ABOVE. PLEASE MAKE SURE TO INCLUDE YOURSELF:

PLEASE LIST YOUR GUEST INFORMATION BELOW TO REGISTER FOR THE EVENT ON 11/16/2018
I AM REGISTERING THE FOLLOWING NUMBER OF NON-BCDA MEMBER DENTISTS AT $270/PERSON
I AM REGISTERING THE FOLLOWING NUMBER OF STAFF MEMBERS AT $145/PERSON
Total Due
Please remember your payment total as you will need to enter this total when you submit your payment after submitting this registration form.
PLEASE LIST THE NAMES OF THE REGISTRANTS ABOVE. PLEASE MAKE SURE TO INCLUDE YOURSELF:

Seating, meals and CE credits will NOT be reserved without payment.

Please remember your payment total as you will need to enter this total when you submit your payment after submitting this registration form.

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Event Registration