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24th Annual Midlands Periodontal Conference: Dr. John Rapley, speaker
November 10-11, 2002

Print this page and send to the address listed below.

 Name:  
 Address:  
 City/State/Zip:  
 Office Phone:  
 Home Phone:  


 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

 

Hotel Reservations:

Make Directly with Headquarters Hotel--- Ask for Midlands Periodontal Conference rates


 The Iowa Society of Periodontology is a Non-Profit Corporation. © 2000 Iowa Society of Periodontology