Membership Type*
- PDTA Member
- PDTA Non-Member
Thank you for being a PDTA member. For members only discounts and pricing, please visit the member's conference registration page.
Attendee Information
Practice Name*
Doctor's Name*
Email Address*
Phone Number*
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Registration Type*
- Non-Member Ticket - Early Bird
Total Number of Assistants / Tickets*
Please enter a number greater than or equal to 1.
List Names All Attendees*
Total
$0.00
Billing Information
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Billing Phone*
Billing Email*
Credit Card*
Card Details
Cardholder Name
Total
$0.00

2900 Delk Road Ste 700 PMB 59

Marietta, GA 30067

Fax: (770) 578-8957
Email: pdtadirector@gmail.com

Attendee Information

Billing Information