Central Palm Beach County Dental Association
Membership Application and Dues Statement.

This form is both our Application and Billing Statement. We appreciate your commitment to organized dentistry and the Central Palm Beach County Dental Association. We have an exciting year of nationally known lecturers and events scheduled. Through our new secure/encrypted website, we have added a registration and payment option through PayPal or credit card.

2017-2018
BILLING STATEMENT

MEMBERSHIP DUES $425.00
TOTAL $425.00

*Life Members only need to fill out registration form with updated information.
If a check is preferred over the secure payment online:
Checks should be made payable to:
CENTRAL PALM BEACH COUNTY DENTAL ASSOCIATION
c/o Colleen Gelsomino
P.O. Box 19555
West Palm Beach, FL  33416