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Thursday, May 19, 2016Registration2:00 p.m. – 7:00 p.m.

Pearls for the Pediatric Dental Patient 3:00 p.m. – 6:00 p.m.Presented by Angela M. Stout, DMD, MPH

Friday, May 20, 2016Registration 7:00 a.m. – 5:00 p.m.

Continental Breakfast 7:30 a.m. – 8:30 a.m.

Adhesive Dentistry Symposium 8:00 a.m. – 11:15 a.m. & 1:00 p.m. – 4:15 p.m.World-class speakers sequentially take the podium.

Insurance Symposium 8:00 a.m. – NoonPresentations by Delta Dental, Dominion Dental (Capital Blue Cross) and United Concordia

PA Age One Connect the Dots Hands-on9:00 a.m. – NoonLimited attendance; sponsored in part by the PA Head Start Association and the DentaQuest Foundation

Exhibit Hall 9:30 a.m.

Poster Session Competition & CE 11:15 a.m. – 12:45 p.m.

OSHA Requirements for Healthcare Practices 1:00 p.m. – 3:00 p.m.Presented by Charles Watts

Luncheon with Wine Tasting (ticketed event)1:00 p.m. – 2:30 p.m.Hosted by APDA at The Hotel Hershey

Penn Dental Medicine Alumni Reception 6:00 p.m. – 7:00 p.m.

Temple university Kornberg School of Dentistry Alumni Reception 7:00 p.m. – 8:00 p.m.

Saturday, May 21, 2016Registration 7:30 a.m. – 2:00 p.m.

Continental Breakfast 8:00 a.m. – 9:00 a.m.

Endodontic Treatment Symposium 8:30 a.m. – Noon & 2:30 p.m. – 4:30 p.m.World-class speakers sequentially take the podium.

Child Abuse Recognition and Reporting for the Dental Professional 9:00 a.m. – 11:00 a.m.Presented by Angela M. Stout, DMD, MPH and Camille Kostelac-Cherry, Esq.

Exhibit Hall 9:30 a.m. – 3:00 p.m.

APDA Board Meeting 9:30 a.m. – Noon

Endo Hands-on Training Noon – 2:30 p.m.Limited attendance; session repeated at 5:00 p.m.

guided Tour of the Milton Hershey School 12:30 p.m. – 1:45 p.m.Hosted by APDA

PDA Business Meeting 12:45 p.m. – 2:30 p.m.Issues Discussion & Legislative UpdateAward Presentations PDAIS Shareholder’s Meeting

Endo Hands-on Training II 5:00 p.m. – 7:30 p.m.Limited attendance

The Amalgamation Celebration (ticketed event) 7:00 p.m. – 11:00 p.m.

Sponsored in part by the Pennsylvania Society of Oral and Maxillofacial Surgeons, the Seventh District Dental Society and Thayer Dental Laboratory.

AGENDA

FuLL NAME:

NICKNAME (FOR BADgE):

ADDRESS:

CITY:

STATE: ZIP:

PHONE:

EMAIL:

DESCRIBE ANY DIETARY ALLERgIES OR ACCESSIBILITY NEEDS:

PENNSYLVANIA’S DENTAL MEETINGMay 19-21, 2016 | Hershey Lodge

Registration Form (one form per person, please)

m PDA Member Dentist

m ADA Member Dentist

m Non-Member Dentist

m Dental Hygienist

m Dental Assistant

m Non-Licensed Offi ce Staff

Luncheon with Wine TastingHosted by APDA at The Hotel HersheyFriday, May 20 @ 1:00 p.m.$70 per attendee x ____ = ____

2016 Hersheypark Tickets (valid any one visit May 6 – September 25, 2016)

$39.50 per Regular Admission (ages 9-54) x ____ = ____

$29.50 per Junior/Senior Admission (ages 3-8 & 55-69) x ___ = ____

$23.00 per Senior Plus Admission (ages 70+) x ____ = ____

SOCIAL EVENTS

Please check one:

Additional Attendees NOT attending courses or the exhibit hall will need a name badge. Please list ad-ditional attendees:

FuLL NAME NICKNAME

FuLL NAME NICKNAME

floating page

m Dental Hygienist

m Dental Assistant

m Non-Licensed Office Staff

By 2/29 By 4/1 After 4/1 By 2/29 By 4/1 After 4/1

May 19 Pediatric Pearls @ 3:00 p.m.

m $75 m $100 m $125 m $175 m $200 m $225

May 20 Adhesive Dentistry Symposium 8:00 a.m. - 4:15 p.m. (dentist only)

m $175 m $200 m $225 m $275 m $300 m $325

May 20 Insurance Symposium @ 8:00 a.m.

m $25 m $35 m $45 m $25 m $35 m $45

May 20 Age One Connect the Dots Hands-on @ 9:00 a.m.

m $75 m $100 m $125 m $175 m $200 m $225

May 20 OSHA @ 1:00 p.m.

m $50 m $75 m $100 m $150 m $175 m $200

May 21 Child Abuse Recognition & Reporting @ 9:00 a.m. m $50 m $50 m $50 m $150 m $150 m $150

May 21 Endodontic Symposium 8:30 a.m. - 4:30 p.m. (dentist only)

m $150 m $175 m $200 m $250 m $275 m $300

May 21 Endo Lecture with Hands-on @ Noon (dentist only)

m $450 m $750 m $750 m $650 m $850 m $850

May 21 Endo Lecture with Hands-on @ 5 p.m. (dentist only)

m $450 m $750 m $750 m $650 m $850 m $850

May 20 & 21 Exhibit Hall Only (includes CE on the exhibit floor)

m $50 m $50 m $50 m $50 m $50 m $50

Select Courses Tuition includes continental breakfast and breaks. Lunch is on your own.

May 21 PDA Business Meeting @ 12:45 p.m. complimentary

m

m

m Not

AvailableNot

AvailableNot

Available

PDA/ADA Members, Hygienists, Assistants & Non-Licensed Staff

Non-Member Dentists

Guided Tour of the Milton Hershey School Hosted by APDA Saturday, May 21 @ 12:30 p.m. Complimentary x ____

The Amalgamation Celebration Saturday, May 21 @ 7:00 p.m. $80 per attendee x ____ = ____ $30 per child 12 and under x ____ = ____ Let’s mix together food, fun, drinks & dancing! Dress code is black-tie or a dark suit.

Dental Student Funding Buy a ticket for a dental student to attend The Amalgamation Celebration. $80 per dental student x ____ = ____

Course Tuition Total $________________

Social Event Total $________________

Total Due $________________

Method of Payment Please make check payable to: PDA and mail with completed form to P.O. Box 3341, Harrisburg, PA 17105 or fax your registration to (717) 232-7169 or register online at www.padental.org/PDM

m Check m MasterCard m Visa m American Express m Discover

CARD NuMBER ExP. DATE

SIgNATuRE

Registrations accepted until April 29, 2016. Cancellations must be received in writing by May 9, 2016. No refunds will be issued for registrations cancelled after May 9. Cancellations can be faxed to (717) 232-7169 or emailed to rvn@padental.org.

Questions? Contact Rebecca Von Nieda at (717) 234-5941, ext. 117 or rvn@padental.org.