2019 AP Westfall Registration

Name *

First Name Last Name

Email *

example@example.com

Phone Number *

- Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Name of Spouse or Guest(s) if planning to attend

Meeting Registration

Includes one ticket to Friday, June 7 business lunch and 6 hours of CE credit

Please select one of the following:

Member Registration Guest (parent, spouse, or child of active member) Guest (orthodontist accompanied by a member) Retired Member 2018 Graduate Current Resident Full time UT faculty

Please select one of the following:

Member Registration Guest (parent, spouse, or child of active member) Guest (orthodontist accompanied by a member) Retired Member 2018 Graduate Current Resident Full time UT faculty

Friday Night Backyard Bash

This year we are changing up the Friday night event. Join us Friday June 7 from 6:30-9:00 for a casual meal near the pool. There will be an open bar, face painting, and baloon artists.

Adults Attending ($25 each)

Children 12 And Under Attending ($25 each)

Ages of Children Attending

Please list any dietary restrictions

Golf Tournament

The tournament will be held Saturday June 8 from 12:00-6:00 and is $225 per golfer. Registration fee includes green fees, cart, and boxed lunch.

How many golfers in your party?

Do you have any pairing requests?

Total

Total Registration Fee

USD Your total will be charged via PayPal on the following screen. After completing the payment process you will receive an email receipt and a list of your registration selections.