Annual Session 2024 Attendee Registration for NonmembersΔFirst NameLast NameEmailPhoneAddressAddress Line 1Address Line 2CityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)ReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweRegistration Type: Registered Dental Hygienist (current non-ADHA member) Dentist Dental Assistant Other Office Team MemberWhich Days Are You Attending?Friday and Saturday ($228.80)Friday Only ($150.80)Saturday Only ($124.80)Will you require a vegetarian meal option? (Friday, Chipotle) Yes NoOn Saturday, general attendee session ends at 12:30, so lunch with the RDH students is OPTIONAL for an additional $10 fee, from 12:30-1:30 PM. Lunch will be available from the Raven Rock Pizza food truck, and your $10 purchase will include 1 Personal Pizza & 1 Drink (soda or water). Students have a session from 1:45-3:00 PM, so will be staying for lunch and then attending their session. All attendees will also have the option to bring cash or card and pay for food in person. If you have any questions, please email Nicole @ AnnualSession@OKDHA.org *4% online processing fee makes the added total $10.40 per added lunchWould you like to purchase & attend optional lunch with the RDH students on Saturday, 12:30-1:30 PM, Raven Rock Pizza? Yes, I would like to purchase an optional Saturday lunch. No, I do not want to purchase an optional Saturday lunch.Saturday Lunch (Optional) Personal Pizza + Drink Quantity (Personal Pizza + Drink)Are you attending our FREE Barbie Bowling event? (Bowling & shoes included. Must be age 21+ AFTER 8 PM. Food & Drinks avail. for purchase) Yes NoAre you age 21+? Yes NoNo payment items have been selected yetAll requests for refunds must be made in writing to web@okdha.org. Refunds will be considered until July 31st (this must be decided on by our board). After July 31st, no refunds will be issued. Thank you for your understanding. By selecting this checkbox you are agreeing to our refund policy.Submit Form