Halloween Candy Buyback Registration Form 2020
This form in addition to a $25 registration fee will register your practice for the 2020 installment of the Halloween Candy Buyback with a listing on halloweencandybuyback.com.

Within 48 hours of submitting your form, you will receive an email with a link to paypal from our partner the Dental Pro Shop for your registration fee.

Once we receive confirmation of your registration payment from paypal, it takes 24-48 hours for your practice to be newly listed on the Halloween Candy Buyback website. Please email hcbb13@gmail.com if your website does not show up 4 business days after registration.
Email address *
Did you register with Halloweencandybuyback.com in 2019? If you aren't sure, please check the site now. All of the 2019 listings are still up and will be removed on Oct. 23rd unless we receive a paid registration for this year *
If you registered in 2019, are you making any changes to your listing?
Clear selection
Practice or Business Name *
Contact Person *
Practice location (Address) *
City *
State *
Zip Code *
Phone (will be included in listing) *
Website *
All information provided except "contact person" will be included in your listing. If you don't want something included, let us know here!
Check the HCBB website halloweencandybuyback.com for event set up tips & donation instructions
A copy of your responses will be emailed to the address you provided.
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