Register for KADA + KAOMI 2022

Step 1: KADA Registration

Name

Gender

Male Female

Dental License No.

Phone

Practice Address

Practice Type

Private Corporate / Large Group Practice Community Health Academia / Dental School

Size of Practice

1-5 Staff 6-10 Staff 11-25 Staff 26+ Staff

Undergraduate School

Dental School

Specialty

Years in Practice

Years as an ADA Member

What information(s) are you most interested in obtaining?

Practice Management Clinical Techniques Work/Life Balance Corporate vs Private Practice Other

Tell us about yourself! What are your interests outside of dentistry?

Certification

I certify the information I provided on and in connection with this form is true and correct to the best of my knowledge. I also understand that any false statements or deliberate omissions on this form may subject me to legal actions for fraudulent misrepresentation.