Haddad Seminar Registration

Back to Haddad Memorial Seminar

Registration Form

27th Annual Dr. Michelle E. Haddad Memorial Seminar

Date
03/17/2023 8:00am - 5:00pm (in person)

Registration Fees
Dentists: $250.00
Auxiliary Staff: $100.00
Former Residents and Attendings: $100.00
Former Residents and Attendings Auxiliary Staff: $50.00

* indicates required field

Attendees
Enter first and last names of each attendee; Include ADA# for each registrant for verification certificate:
First Name
Last Name
ADA #
Registration Type
Attendee 1

Add Another Attendee

Contact Information
Billing Address
Please note that, when paying by credit card, the participant address used for registration MUST match the address on record for the credit card being used.
Payment
Total
Payment Type
image/svg+xml
3 or 4 digit code on back of card