Halloween Candy Buyback Registration Form 2019
This form in addition to a $25 registration fee will register your practice for the 2019 installment of the Halloween Candy Buyback. After you submit this form, the confirmation you receive will have 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 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 *
Practice or Business Name *
Your answer
Contact Person *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Website *
Your answer
After you submit your registration, go to the paypal link you see on your submission confirmation to pay the $25 registration fee through our partner the Dental Proshop. After you submit your payment, you will be redirected to your fabulous offer from XLEAR our 2019 sponsor! Be sure to provide your practice name & address in the shipping address that paypal requests so that we can confirm registration & payment. Thank you!
Check the HCBB website for event set up tips & donation instructions
A copy of your responses will be emailed to the address you provided.
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