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 *

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? *

If Other, Write a Description

Are you attending the Friday night social & trivia?

If you are attending the Friday Night Social, are you bringing a guest?

If you are an ODA member, which dental component do you belong to?

Dietary Needs

Additional Information

Cardholder first name *

Cardholder last name *

Billing address *

Billing city *

Billing state *

Billing zip *

Payment Amount: $0.00