2025 Pediatric Dentistry Alumni Day

RSVP Information

Registration
Select	Description	Amount

	Pediatric Dentistry Alumni (CE) - $199 (Not tax deductible)
	General Attendance (CE) - $299 (Not tax deductible)
	UCLA Staff or Current UCLA Pediatric Dentistry Residents - Free (CE)
	Non-UCLA Resident (CE) - $90 (Not tax deductible)
	Auxiliary Attendance (CE) - $90 (Not tax deductible)
	Guest (social hour and evening program only) - $60 (Not tax deductible)

Sub-Total:
Tax-Deductible:

Donation Option

If you would like to contribute an additional gift or are unable to attend but would like to support UCLA Pediatric Dentistry with a tax-deductible donation. please click here.

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Tax-Deductible:

Contact Information

Personal

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Additional Information

	Job Title:
	Company Name:
	Please list any UCLA Alumni Networks you are a member of:
	* Gender Pronoun:	*
	Do you have any accessibility requests?:
	* UCLA Affiliation:	*
Guest Information The following fields are required for all of your additional guests. If you are the main registrant, no need to include yourself below as we have your information above.
Your First Guest:
	* First Name:
	* Last Name:
	* Gender Pronoun:
	Do you have any accommodations requests?:
	* UCLA Affiliation:
	* Email address:
	* Alumnus/a of UCLA?:
	UCLA graduation year:
Your Second Guest:
	* First Name:
	* Last Name:
	* Gender Pronoun:
	Do you have any accommodations requests?:
	* UCLA Affiliation:
	* Email address:
	* Alumnus/a of UCLA?:
	UCLA graduation year:
Your Third Guest:
	* First Name:
	* Last Name:
	* Gender Pronoun:
	Do you have any accommodations requests?:
	* UCLA Affiliation:
	* Email address:
	* Alumnus/a of UCLA?:
	UCLA graduation year:
Your Fourth Guest:
	* First Name:
	* Last Name:
	* Gender Pronoun:
	Do you have any accommodations requests?:
	* UCLA Affiliation:
	* Email address:
	* Alumnus/a of UCLA?:
	UCLA graduation year:
Your Fifth Guest:
	* First Name:
	* Last Name:
	* Gender Pronoun:
	Do you have any accommodations requests?:
	* UCLA Affiliation:
	* Email address:
	* Alumnus/a of UCLA?:
	UCLA graduation year:
Your Sixth Guest:
	* First Name:
	* Last Name:
	* Gender Pronoun:
	Do you have any accommodations requests?:
	* UCLA Affiliation:
	* Email address:
	* Alumnus/a of UCLA?:
	UCLA graduation year:
Your Seventh Guest:
	* First Name:
	* Last Name:
	* Gender Pronoun:
	Do you have any accommodations requests?:
	* UCLA Affiliation:
	* Email address:
	* Alumnus/a of UCLA?:
	UCLA graduation year:
Your Eighth Guest:
	* First Name:
	* Last Name:
	* Gender Pronoun:
	Do you have any accommodations requests?:
	* UCLA Affiliation:
	* Email address:
	* Alumnus/a of UCLA?:
	UCLA graduation year:
Your Ninth Guest:
	* First Name:
	* Last Name:
	* Gender Pronoun:
	Do you have any accommodations requests?:
	* UCLA Affiliation:
	* Email address:
	* Alumnus/a of UCLA?:
	UCLA graduation year:

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