LDA Last Chance Seminar Registration


Friday, December 13, 2013

Renaissance Hotel
Baton Rouge, LA


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C.E. Seminars
Fee Per Person
# Attending

LDA Members
$159
ADA Members
$219
Non-members
$299
Hygienist
$129
Assoc. Members
$89
Dental Staff
$89
Ret. Vol. Lic.
$49
Dental Student
Free - You must register.
2013 Dental School Graduate
$79
*Add LATE FEE of $25 per person after Nov. 22
$25
$15 Credit card convenience fee
(non-refundable)

Total amount of fees due to the LDA =
(Please enter your total)

Please list names of anyone registering with you:




I will pay by: Check or Credit Card

If paying by check, please mail to:

LDA
Last Chance Seminar
P.O. Box 261173
Baton Rouge, LA 70826-1173

If paying by credit card,
please enter the information below:

Visa/Master Card Number:
Expiration Date:
Name as it appears on card:
3 digit security code on back of card:

Questions or Comments:




NOTE: There is a $15 non-refundable convenience fee for each credit card transaction.

C.E. registration includes lunch and continental breakfast.

Cancellation Policy:
After November 22, 2013, refunds will be given only with the approval of the LDA Council on Dental Education. In the unlikely event the meeting is cancelled, all C.E. registration fees will be refunded, less proportional costs of materials already produced and distributed.