Academic Meeting Participation Fees
（check the box that applies to you）
Type of registration
Members must register as “members.” Changes cannot be made after registration.
Member dentist \27,000
Non-Member dentist \31,000
Member dental technician \12,000
Non-member dental technician \15,000
Member dental hygienist \12,000
Non-member dental hygienist \15,000
Dental assistant \12,000
The information entered will be printed directly onto your name card.
Please be sure to enter information accurately.
Be sure to enter your membership number if you have one.Your membership number is printed on the back of your member’s card.
Please make sure you have entered your e-mail address accurately.
Name of your office/workplace
Address for sending materials