ODA Regional Event: CE on the Ranch
Saturday, November 2nd, 2024
with kick-off social & trivia night Friday, November 1st from 6:00 PM to 8:00 PM
Brasada Ranch
16976 SW Brasada Ranch Rd
Powell Butte, OR 97753
Fill out the following form to register to attend this event. These rates will increase on October 2nd.
To book the special $199/night rate in a King Cabin Guestroom at Brasada Ranch, call 877-771-4239 no later than October 2nd.
Primary Registrant
Registration Category
*
ODA Member Dentist-$175.00
ODA New Member Dentist (graduated between 2013-2023)-$100.00
Non-ODA Member Dentist-$250.00
Dental Team Member-$75.00
Boots & Bling Party Only-$50.00
First Name
*
Last Name
*
Dental Credentials (i.e. DMD, DDS,RDH)
ADA Number
Phone
*
Email
*
Address
*
City
*
State
*
Zip
*
Dental school graduation year
What is your role on the dental team?
*
ODA Dentist
Non-Member Dentist
New Dentist
Hygienist
Dental Assistant
Laboratory Tech
Dental Student
Other
If Other, Write a Description
Are you attending the Friday night social & trivia?
Yes
No
If you are attending the Friday Night Social, are you bringing a guest?
Yes
No
If you are an ODA member, which dental component do you belong to?
Central Oregon Dental Society
Clackamas County Dental Society
Clatsop County Dental Society
Eastern Oregon Dental Society
Klamath County Dental Society
Lane County Dental Society
Marion & Polk Dental Society
Mid-Columbia Dental Society
Multnomah Dental Society
Rogue Valley Dental Society
Southern Oregon Dental Society
Southern Willamette Dental Society
Southwestern Oregon Dental Society
Umpqua Dental Society
Washington County Dental Society
Yamhill County Dental Society
Dietary Needs
Additional Registrant
Reset Form
Additional Information
Cardholder first name
*
Cardholder last name
*
Billing address
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Billing state
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Payment Amount:
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