Fall Conference Registration

Step 1

* denotes required fields

Conference Rates ($100 added if you pay after September 3, 2010)
Rates include: seminars, meals and breaks

Registration fees are fully refundable prior to September 3, 2010. After that date, you must call for credit. Most CE seminars are deductible for doctors and staff. Check with your accountant.

There are multiple pages to this application and they are easy to navigate. Please fill this out entirely whether you are registering by Check or online.

Contact Information

DC Registrant's name that will appear on check or credit card

*DC's First Name:
*DC's Last Name:
Spouse First Name:
* Address:
* City:
* State:
* Zip:
* Phone:
Fax:
Email:

* Select One

$169.00 SDCA Member (After September 3, 2010 $269.00)

$199.00 SDCA Member and Spouse (After September 3, 2010 $299.00)

$269.00 Non-member (After September 3, 2010 $369.00)

$90.00 New DC Licensed in 2008.

$115.00 New DC Licensed in 2008 and Spouse.

$75.00 New DC Licensed in 2009.

$120.00 New DC Licensed in 2009 and Spouse.

$50.00 New DC Licensed in 2010.

$95.00 New DC Licensed in 2010 and Spouse.

$299.00 (Non SDCA member but member of home State Association)

$199.00 Reciprocity Rate

C-PAC Contribution (Voluntary, $200.00 suggested) C-PAC donations must be paid by personal check or credit card.

Foundation Raffle Tickets $20.00 each