On-Line
Registration
Payment Options
If paying by CHECK-Mail:
Make checks
payable to: GHDHS (Greater Houston Dental Hygienists’
Society)
Please PRINT & mail your registration form and remittance to:
GHDHS
c/o
Ushma
Ramaiya,
3806 Sunny Orchard Drive, Richmond, TX 77407
For more information contact
Nisa:
GHDHSCE@gmail.com
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If
paying by credit card:
You still must mail in this filled out page (registration form) to above address, but can pay
online to insure early registration price. Confirmation will be sent via
email. Simply choose the drop down specialty, then add the name of the
registration and click the "Pay Now" button. You will be redirected to the
PayPal Website, where you can complete your online credit card payment.
You will be able to Click on one of a links below. PLEASE BE SURE YOU ARE UNDER THE CORRECT DATE. If paying for more then one person, simply fill out a new Form and Paypal will keep a running tally of registrations in a "shopping cart" until you are ready to Check-out. You can click on "Continue shopping" on the next screen and it will redirect back to this page. For error issues or questions, please contact the webmaster at sbassrdh@gmail.com or 281.980.8524. Thank you!
Greater Houston Dental Hygienists’ Society
Presents
Melting Tooth Syndrome and Breakthrough Biofilm Concepts!
Presented by Anne Nugent Guignon, RDH, MPH
Two Great Courses!
Melting Tooth Syndrome..Recognizing, Preventing, and Treating Erosion and Dentinal Hypersensitivity.
Breakthrough Biofilm Concepts..Dealing with Mother Nature’s Microbial Masterpieces.
|
Friday, October 28,
2011 |
Hilton Houston
Westchase |
Registration Form (Please Print legibly)
Check one: □ RDH □ DDS □ DA □ Office Staff
Name: ______________________________________ ADHA Membership #: ____________
Address: ___________________________ City: ___________ State:______ Zip Code: ______
Home Phone#:
_________________ E-mail address: _________________________________
(Confirmation by email only)
Please note: Participants will be able to download the handouts to their computer, Netbook, or iPad, in a file that can be printed. No handouts will be available onsite.
Continental Breakfast AND lunch included
Early Bird Registration: (postmarked on or before October 14, 2011)
| ADHA Member RDH _______ $95.00 | |
|
Non-Member RDH, DDS, DA, Office Staff: ______ $140 |
Post Marked
October 15,
2011
or after:
| ADHA Member RDH _______$110.00 |
[ ] $5 of your registration fee will be donated to TX HY-PAC unless you check the box. Visit our website at www.ghdhs.org for more information on TX HY-PAC.
GHDHS Accepts
Checks, Money Orders or Credit Cards (for credit cards payments go to
www.ghdhs.org click on CE courses and follow instructions for Pay
pal). Cancellation must be made by October 21, 2011 and requires a written notice. All refunds are subject to a $25.00 fee. No refunds will be given after October 21, 2011, No exceptions. A $5 will be charged for any changes made to your registration after October 21 , 2011. All refunds will be mailed after the CE. For more info contact Nisa at GHDHSCE@gmail.com Make Checks payable to: GHDHS Please mail your registration form and remittance to:
GHDHS
c/o |