SCDL Official 2016 Online Registration Form Survey

Please complete each question of the official online registration form. Use "none" or "N/A" in fields that are not applicable.

1.Please complete the following:

Laboratory/Company

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Fax

FL Lab License # (if applicable)

REGISTRATION CATEGORIES & FEES

Member rates apply to SCDL members in good standing, educators, civil service and active military personnel. Name badges are required at all functions. Requests for reasonable accommodations, as provided by the ADA, must be received in writing in the SCDL office by 3/2/16.

FULL REGISTRATION:
SCDL Members, Educators, Civil Servants, Active Military: $59
Non-Members: $228*
Includes Fri/Sat Technology Summitpresentations; Fri/Sat Leadership Summit presentations (max. two per lab); Friday evening Cocktail Reception; Sat lunch; exhibits; table clinics; breaks. Eligible for door prizes.
*Non-member registration includes 2016 SCDL Laboratory Membership, which entitles all additional registrants from this lab to register at member rates.

SCDL Member BOGO Special!
For every Full Registration, you may register an additional person from your SCDL member laboratory at half price ($29.50). Offer expires February 29, 2016.

LEADERSHIP SUMMIT
The Leadership Summit is limited to two (2) participants per laboratory. Please note that Leadership Summit content is appropriate for laboratory owners/managers.

EXHIBIT HALL ONLY PASS:
SCDL Members, Educators, Civil Servants, Active Military: FREE
Non-Members: FREE
Includes exhibits, table clinics. Eligible for door prizes. Does not include CE credits, seminars, meals, or breaks.No CE credits available with Exhibit Hall Only Pass.

OPTIONS & EXTRAS:
Saturday Lunch: $30 per ticket
Saturday, March 19; 11:15 AM -- 12:00 PM OR 12:00 PM -- 12:45 PM. Lunch included with Full Registration. Must indicate time below.

2.FIRST ATTENDEE REGISTRATION: Please complete all requested information.

Full Name

Nickname

CDT/RG/DDS/DMD/Other

CDT #

Food Allergies

3.Please select the answer that best describes your membership.(Required.)

SCDL Member/Educator/Civil Servant/Active Military

Non-Member/Exhibitor

4.Registration Type

Full Registration

Exhibit Hall Only Pass (No CE Credits)

6.Will you be attending the Leadership Summit?
The Leadership Summit is limited to two (2) participants per laboratory. Please note that Leadership Summit content is appropriate for laboratory owners/managers.

Yes

7.Options & Extras

Saturday Lunch: $30(Included with Full Registration.)

8.Attendee Total:

9.Do you have additional attendees?(Required.)

Yes