NYDHA Empire Conference/Annual Session Registration Form

November 4-6, 2022 - Hyatt Regency Rochester, Rochester NY

Name:*
Address:*
Phone:*
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E-mail:*
Is this your first conference?
Registration type:*

* Not yet a member? Use the member rate if you join now.
** Pre-Registered student informative poster presentation participants are exempt from paying registration fee. 

Event Registration  Please check the box below for events you will attend.

Conference Registration entitles your entry into Continuing Education Courses, Exhibitors’ Hall on Friday and Sat- urday, Friday and Sunday morning House of Delegates meetings, Friday morning Candidates’ Forum and Reference Committee Testimony sessions, Student Informative Poster Presentations, Silent Auction, and Sunday morning House Installation of Officers and Directors.

Specially ticketed events:Current Issues Luncheon (Course #7) and President’s Reception/Dinner on Saturday are not included in the registration fee. Please see Special Events below to register.*
Courses:
         Course #1   Friday, 1-5:30 p.m.                 4 CE       Hands on Instrumentation CE: Advanced Scaling and Root Planing (Course Filled)
Special Events:
Total Registration and Special Event Fees (please use numbers only, no periods):*
 $ 
Please note any dietary restrictions:
Please note any disability requirements:

Cancellation Policy: Written notice of cancellation accepted if postmarked by Oct. 3, 2022. Written cancellations postmarked after Oct. 3 subject to a $30.00 processing fee. Sorry, cancellations after Oct. 24 cannot be honored.

NOTE: When you click on Submit, you will be taken to PayPal to complete your payment securely. You can use your PayPal account, or use your credit or debit card if you don't have a PayPal account. When you are finished with your payment, you will receive a confirmation email.