Cincinnati Dental Society

Registration for the 2021 Continuing Education Program is now open. To register for the complete series, the 2-day package special or any 1-day program please choose from the list below or click here to download the registration form. You can also register for individual programs or events by CLICKING HERE

Membership:
	Complete Series Any One Day Program 2 Day Package Special

	Dentist Information
Dentist Name:
ADA Number:
Email Address:
Name On Card:
Billing Address:
Billing Address Cont:
Billing City:	State:
Phone:
Additional Attendees:

Full Name:
Full Name:
Full Name:
Full Name:
Full Name:
Total Cost:
Bill Me In:

	Credit Card Information
Credit Card:
Card Number:
Expiration:	(yyyy)

	Please register me for all five courses. I understand that if I am unable to attend I should contact the Executive Office by the Friday preceeding each course. If I fail to do so I will be invoiced $35 for lunch.
	Do not register me for all five courses. I will confirm my attendance by notifying the Executive Office by the Friday preceeding each course. If I fail to do so, a lunch and continuing education card will not be available the day of the course.

PLEASE NOTE: ASSOCIATE MEMBER ANNUAL FEES ARE $130.00. IF YOU WOULD LIKE ADDITIONAL INFORMATION ON BECOMING AN ASSOCIATE MEMBER OF THE CINCINNATI DENTAL SOCIETY, PLEASE CONTACT THE EXECUTIVE OFFICE AT (513) 984-3443.

Payment by credit card only. By submitting this form you authorize the Cincinnati Dental Society to charge the amount shown in the total box above to the credit card listed on this page. Please only click the 'Register' button once, depending on your connection, processing could take several seconds. Clicking multiple times could result in multiple charges being processed.