Alumni Registration
Dental Congress
Class of 2023

* - Required field

Email Address:*

Re-Type Email:*

User Name:*

Max of 12 Characters only

Password:*

Max of 8 Characters only

Attending ?:*

Yes Maybe No

First Name:*

Last Name:*

Do not hyphenate your last name the system will do that automatically for name tag printing using your current Last name and your Maiden name.

City:*

State*

State 2 Letter Abbreviation

Country:*

USA CAN GBR MEX ABW AUS AUT BHS BGD BEL BMU DNK EGY FJI FIN FRA GEO DEU GRL HKG HUN ISL IND IDN IRL ISR ITA JAM JPN LUX MAR NAM NLD NZL NOR PHL PRI REU LCA SAU ZAF ESP SWE CHE VGB VIR ZWE

Maiden Name:

Enter only if different than current last name.

Spouse/Guest Name:

If your guest is also a Alumni they must register separately as well.

Spouse/Guest Attending:

Yes No NA

Online Yearbook Information (optional) Only Alumni who are logged in will be able to see this information never the general public.

Current Photo:

Facebook:

Current Street Address:

Phone:

Children:

First Name - Birth Yr separate each by commas.