Conference Registration

Please complete one registration form per attendee.

Early registration ends April 1, 2025. After April 1, an additional $25 will be added to all registration fees.

First Name *

Last Name *

Credentials

Practice Name/DDS Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Dietary Restrictions

Early Registration: on or before April 1 (ONE attendee per registration form) *

Current Total:

$0.00

Discount Code

Liability Statement: *

I am agreeing that by registering for this event I will indemnify and hold harmless Michigan Association of Orthodontists, its volunteers, employees, and others working on behalf of the Association against any and all claims, demands, suits, or loss, including all costs connected therewith, and for any damages which may be asserted, claimed, or recovered against or from Michigan Association of Orthodontists including loss of life.

Cancellation Policy: *

All cancellation requests must be received in writing by April 7, 2025 and will be charged a $15 processing fee. No refunds will be granted after April 7, 2025.