Ventura County Dental Hygienists' Association

CE Registration
Registration form for CE's:
 
Snail Mail-Checks Only
Print a copy of the registration form and send it with check payable to VCDHA.  Mail to: Peggy Lee RDH, 132 Mesa Dr. Camarillo, CA 93010.

Click Here for Printable Snail Mail Registration Form

OR
 
E Mail and PayPal payment
Fill out registration form below and send with confirmation of PayPal payment. When using PayPal please send money to vcdha805@aol.com and make sure to put "CE payment" in subject line. In the message area put your name to match the registration form.

ONLY USE PAYPAL IF YOU HAVE YOUR OWN PERSONAL PAYPAL ACCOUNT LINKED TO YOUR CHECKING ACCOUNT OR CREDITCARD.

PLEASE DO NOT SEND YOUR CREDIT CARD INFORMATION TO PEGGY LEE OR TO THIS EMAIL ADDRESS.  

IF USEING PAYPAL AS YOUR METHOD OF PAYMENT PLEASE CHECK TO MAKE SURE IT WAS A SUCCESSFUL TRANSATION BECAUSE WE WON'T HAVE A RECORD OF YOUR REGISTRATION WITH OUT PAYMENT.

Additional Options

Contact information:
First name:
Last name:
Email address:
License # and ADHA #
Mailing address:
CE Information
Include: CE Course Title, Name(s) of attending with license number, Member or Non-Member Price, and Method of Payment.
Best way to contact you: