Southern Spring Seminar Registration Form

For a small convenience fee you can register online at                      

EventBrite UDHA

Or mail this registration form with check or money order to:

Anita Herzog, Southern Component Utah Dental Hygiene Association

66 E 3930 S

Washington UT 84780

Checks payable to:  Southern Component of UDHA

Participant Name______________________________    ADHA number_____________


 All day registration, breakfast and lunch included       Member  $   60          Non-member  $ 130

Half day registration, no meals included                      Member  $   35          Non-member     $ 70

Student registration, meals included                                            $   25


 Please bring this registration form with you at sign in.

Event will be located on the northeast corner of the Recreation Center in the banquet room.