2025 NDHA Membership and Convention Registration

Your Information

First Name

Middle Name

Last Name

Date of Birth (Month/Day)

Phone

Street Address

City

State

Zip Code

License Information

Graduation Year

Dental Hygiene School Attended

Credentials (e.g. BS, MS, Phd)

License Number

License State

Membership Type

Membership Categories

Would You Like To Make A One-time Donation?

YesNo

Donation Amount

Would You Like To Register For The Convention?

YesNo

Convention Registration

CONVENTION MEMBER/NON-MEMBER REGISTRATION FEE

INCLUDES:

Admission to all NDHA/NDA/ Scientific sessions
NDHA Get Acquainted Activity
NDHA President’s Breakfast
NDA Opening Ceremony & Opening Celebration
Technical Exhibits, and Table Clinics.

A registration badge is required for admission to all CE and to access

the Exhibit Hall. Tickets are required.

Registration Type

Which Day?

Would You Like To Register A Guest(s) The Convention?

YesNo

Guest Registration

GUESTS (Non-Dental Professionals) = $ 55.00

How Many Guests Would You Like To Register?

Guests Full Name

Additional Tickets

CPR Registration - $68.00 Quantity

Comedy Show Ticket(s) - $65.00 Quantity

Additional Get Acquainted Ticket(s) - $75.00 Quantity

Additional President's Breakfast Ticket(s) - $80.00 Quantity

Total

Dues Amount:

Convention Registration Amount:

Guests Registration Amount:

Additional Get Acquainted Amount:

Additional Breakfast Amount:

CPR Amount:

Comedy Show Amount:

Donation Amount:

Total Amount Due Today:

If you have any questions please contact Laverna Wilson, Treasurer lwabuelita@gmail.com / 215-285-6140-cell

Payment Information

Payment Method

Credit CardCheck

Name on Card

Billing Email

Card Number

Code

Check Information

Please make checks payable to: National Dental Hygienist Association

Mail your payments to:

366 East Gorgas Lane

Philadelphia, PA 19119

National Dental Association