Online Registration

Avoid Liability: Know Your Patients' Medications and Their Impact on Dental Treatment!

Wednesday, February 25, 2015
9:00 a.m. - 4:00 p.m.

The Crowne Plaza, Warwick, RI

Please complete the form below to register online for this course. Be sure to include all attendees from your office. You will then be directed to the payment page where you can securely enter your credit card information or choose to mail a check, if necessary.

Dentist
First Name
Dentist
Last Name
Address

Note: We must have an actual street address, not a PO Box, for billing purposes.
City
State/Zip
Telephone
Email
List the names of those attending from your office, including yourself. Your badge will be printed exactly like this:
Prefix First Name MI Last Name

RIDA member, $0.00
Spouse/Staff of RIDA Members, $60.00
Spouse/Staff of Non Members, $85.00
Out-of-State ADA Members, $175.00
Affiliate Members, $150.00
Non-ADA Members of ADA, $325.00

RIDA member, $0.00
Spouse/Staff of RIDA Members, $60.00
Spouse/Staff of Non Members, $85.00
Out-of-State ADA Members, $175.00
Affiliate Members, $150.00
Non-ADA Members of ADA, $325.00

RIDA member, $0.00
Spouse/Staff of RIDA Members, $60.00
Spouse/Staff of Non Members, $85.00
Out-of-State ADA Members, $175.00
Affiliate Members, $150.00
Non-ADA Members of ADA, $325.00

RIDA member, $0.00
Spouse/Staff of RIDA Members, $60.00
Spouse/Staff of Non Members, $85.00
Out-of-State ADA Members, $175.00
Affiliate Members, $150.00
Non-ADA Members of ADA, $325.00

RIDA member, $0.00
Spouse/Staff of RIDA Members, $60.00
Spouse/Staff of Non Members, $85.00
Out-of-State ADA Members, $175.00
Affiliate Members, $150.00
Non-ADA Members of ADA, $325.00

RIDA member, $0.00
Spouse/Staff of RIDA Members, $60.00
Spouse/Staff of Non Members, $85.00
Out-of-State ADA Members, $175.00
Affiliate Members, $150.00
Non-ADA Members of ADA, $325.00

RIDA member, $0.00
Spouse/Staff of RIDA Members, $60.00
Spouse/Staff of Non Members, $85.00
Out-of-State ADA Members, $175.00
Affiliate Members, $150.00
Non-ADA Members of ADA, $325.00

RIDA member, $0.00
Spouse/Staff of RIDA Members, $60.00
Spouse/Staff of Non Members, $85.00
Out-of-State ADA Members, $175.00
Affiliate Members, $150.00
Non-ADA Members of ADA, $325.00

Cancellation/Refund Policy
Full refund given with notice of cancellation 72 hours prior to the course.

 



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©2003-2013
Rhode Island Dental Association
875 Centerville Commons, Bldg. 4, Suite 12 | Warwick, RI 02886
(401) 825-7700
(401) 825-7722, fax