24th Annual Midlands Periodontal Conference: Dr. John Rapley, speaker
November 10-11, 2002
Print this page and send to the address
listed below.
| Name: |
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| Address: |
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| City/State/Zip: |
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| Office
Phone: |
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| Home Phone: |
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| Fees
*2 Day Registration |
1 DAY Sunday |
1 DAY Monday |
| Dentist |
No_____ |
@$225 |
No_____ |
@$175 |
No_____ |
@$175 |
| Hygienist |
No_____ |
@$125 |
No_____ |
@$100 |
No_____ |
@$100 |
| Assistant |
No_____ |
@$125 |
No_____ |
@$100 |
No_____ |
@$100 |
| Student |
No_____ |
@$30 |
No_____ |
@$30 |
No_____ |
@$25.00 |
*all fees are based on registration received by October 15, 2002.
Please add $25.00 per person late registration fee after October 15,
2002.
Send Registration Form and Make
Checks Payable To:
Iowa Society
of Periodontology
4900 Westown Parkway, Suite A-4
West Des Moines, Iowa 50266
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Hotel
Reservations:
Make Directly with Headquarters
Hotel--- Ask for Midlands Periodontal Conference rates
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