Mid-Atlantic P.A.N.D.A. Seminar Request 2019
Non-Profit EIN: 80-0306567

Please note your seminar will be confirmed when all of the following information is received and approved by your Mid-Atlantic P.A.N.D.A. Trainer.
Name of Organization requesting seminar: *
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Organization’s Contact Person Name: *
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Organization’s Contact Person Email: *
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Organization’s Contact Person Phone Number: *
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Organization’s Contact Person Fax Number:
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Seminar Date: *
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Seminar Start and End Time: *
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Location of Seminar: *
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Anticipated Number of Participants: *
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The organization is required to provide AV equipment for the presentation, which includes an LCD projector and laptop with USB drive capable of handling a power point presentation.
Cost Structure
A goal of Mid-Atlantic P.A.N.D.A. is to provide continuing education regarding abuse and neglect to the dental health community. For our live presentations, our volunteer trainers donate their time and we ask seminar attendees to help support our administrative costs.

Our speaker deposit/base fee is $100 and that will be applied to the course balance.
$20/dentist
$15/non-dentist (hygienist, dental assistant, front desk staff, etc)

I agree to pay a $100 deposit to secure a speaker for my chosen date/time. The deposit will be applied to the course balance.
Thank you for contacting Mid-Atlantic P.A.N.D.A. A representative will contact you to schedule the course.
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