Please fill out the form below to submit your registration information.

After you submit the form, you'll be prompted to submit a $250 conference registration payment via PayPal. You can submit payment by way of a PayPal account; or, you can check out as a guest and pay by debit/credit card.

Registration works best with Chrome, Firefox, and Safari browsers. We recommend NOT using Internet Explorer or Microsoft Edge when registering, as these browsers have had known issues in conjunction with PayPal.

Please register and pay for only one conference attendee per transaction.

Name

First Name

Last Name

Credentials

Please enter your credentials. Check all that apply.

DDS

MD

RN

N/A

Other

If "other," enter credential(s) below:

Email Address

Please enter your email address. We'll use this email address to send you conference updates.

Phone

Please provide the best number at which we can reach you.

(###)

###

####

Mailing Address

Please enter the address to which you would like conference / accreditation information sent.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Would you be interested in presenting on a topic at the Tri-State Dental-Medical Conference?

(Speakers receive a credit of $175 toward their final billing with Boyne Highlands.)

If yes, on which topic would you like to present?