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Individual Registration - National Primary Oral Health Conference


Please complete the form below to register online using our secure shopping cart.

When filling out the form below, please do not use any special characters such as apostrophes, commas, or dashes.

If you prefer to pay by check, please click here.

Please complete a separate form for each individual attending. Name badges and directory of participants will be produced from the information provided below. Please TYPE or PRINT your name clearly.

The "EARLY BIRD" rate of $325.00 is available until September 23, 2010.  ALL REGISTRATIONS AFTER SEPTEMBER 23RD, 2010 WILL BE CHARGED THE ON-SITE REGISTRATION FEE.


Hotel Reservations
Please contact The Gaylord Palms Hotel in Orlando, FL directly to make your lodging reservations or click here to go directly to Hotel Page.

Phone: 487-586-2000. Refer to "Code # A-NOHA" in order to receive the special conference rate of $154.00 plus tax.

(Single/Double) per night plus 14% tax. Rate and availability guaranteed only until September 23, 2010.


PLEASE NOTE - WE ONLY ACCEPT VISA AND MASTERCARD
3-Day Conference Registration Fee (Oct. 24 - 27)
NNOHA Member Participant Fee $325
Non-NNOHA Member Paricipant Fee $375
Federal $325
Registering for Daily Participation Only
NNOHA Member Daily Conference Registration Fee
None
Monday (Oct. 25) $125
Tuesday (Oct. 26) $125
Wednesday (Oct. 27) $125
Monday and Tuesday (Oct. 25 & 26) $250
Tuesday and Wednesday (Oct. 26 & 27) $250
Monday and Wednesday (Oct. 25 & 27) $250
NNOHA Non-Member Daily Conference Registration Fee
None
Monday (Oct. 25) $150
Tuesday (Oct. 26) $150
Wednesday (Oct. 27) $150
Monday and Tuesday (Oct. 25th & 26th) $300
Tuesday and Wednesday (Oct. 26th & 27th) $300
Monday and Wednesday (Oct. 25th & 27th) $300
CPR/AED Review Class, Sunday, Oct 24th, 1pm - 4pm
None
Sunday, Oct. 24: $50.00
Prefix
Last Name
First Name, MI
Credentials
Title (no acronyms)
Organization
Address
City
State
Zip Code
Phone
Fax
Participants Email Address
Email address where confirmation should be sent
Is this your first time attending the NPOH Conference?
No
Yes
Are you a NEW Dental Director?
No
Yes
Attendee Category
Region I - ME, NH, VT, MA, RI, CT
Region II - NY, NJ
Region III - PA, MD, DE, DC, VA, WV
Region IV - KY, TN, NC, SC, GA, FL, AL, MS
Region V - MN, WI, IL, IN, MI, OH
Region VI - NM, TX, OK, AR, LA
Region VII - NE, KS, IA, MO
Region VIII - MT, ND, SD, WY, CO, UT
Region IX - NV, CA, AZ, HI
Region X - WA, OR, ID, AK
Speaker
Federal
Note if any other categories apply
Pre-registration is required for the following session. Choose option to register.
None
Mini Implant Lecture: Sun., Oct. 24 - Noon - 2pm - Unlimited
Mini Implant Hands on Session: Sun., Oct. 24 - 2:30pm - 4:30pm - limit 30pp
Rotary Endo Lecture: Sun., Oct. 24 - 2:30pm - 4:30pm - unlimited
Rotary Endo Hands-On: Tuesday, Oct. 26 - 3:30pm - 5:00pm - limit 25pp
Rotary Endo Hands-On: Wednesday, Oct. 27 - 1:00pm - 2:30pm - limit 25pp

None
Mini Implant Hands on Session: Sun., Oct. 24 - 2:30pm - 4:30pm - limit 30pp

None
Rotary Endo Lecture: Sun., Oct. 24 - 2:30pm - 4:30pm - unlimited

None
Rotary Endo Hands-On: Tuesday, Oct. 26 - 3:30pm - 5:00pm - limit 25pp

None
Rotary Endo Hands-On: Wednesday, Oct. 27 - 1:00pm - 2:30pm - limit 25pp
Special Dietary Restrictions / Food Allergies
None
Rotary Endo Lecture: Sun., Oct. 24 - 2:30pm - 4:30pm - unlimited
Special Needs
NNOHA YEARLY MEMBERSHIP (non-refundable)
None
RENEW my Membership ($25 per individual)
RENEW my Organizational Membership ($250)
Become a NEW Member ($25 per individual)
Become an ORGANIZATIONAL Member ($250)
Conference Activites
None
Annual morning NNOHA "Board" walk
 
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