New York Dental Assistants 2010 Annual Session Registration Form

April 17, 2010

Ramada Inn of Ithaca

2310 Triphammer Rd

Ithaca, NY 14850

Print Page and Mail for Registration Of Meeting

Hotel Accommodations are separate, Information at bottom of registration form

 

Name:________________________________________________________________

Address:_______________________________________________________________

Email Address:___________________________________________________________

(confirmation will be via email)

Phone Number___________________________________________________________

ADAA Member Number_____________________________________________________

Fee:  Member__$75.00

        Non Member__$100.00

Payment due by April 7, 2010.  Fee is $125.00 after cutoff date or registration at door

Payment by check or credit card Send to:

Susan Camizzi

20 Meriden St

Buffalo, NY 14220

Name as it appears on Credit Card________________________type of card________Card number____________________Exp_________

Fee Includes 7 hours CERP Program

Registration for NYDAA Annual Meeting to follow Educational Program

Contintental Breakfast

Lunch

Hot Beverage Service in afternoon

Registration/packet pickup begins at 8:00

Hotel reservations may be made by calling 1-607-257-3100 Price is $99.95 per Night code is DENT by April 1, 2010

If you are attending DANB review held on Friday April 16, 2010 you may register for the member rate.

For more information call Sue at 716-826-7324