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Thank you for registering for the 2021 -- Nebraska Dental Assistants Annual session! 



Here is the two step process to complete your registration:

Step #1. Complete the following contact information in the registration table.

          **Be sure to complete all of the fields! 

Step #2. Click on the appropriate Paypal Icon to complete your payment for your registration.


You will receive an confirmation email from Nebraska Dental Assistants Association within 48 hours of submission.   


 Step #1Complete the information below. Please be sure to indicate EACH day that you will be attending.  After submission of your information, you will be directed to the payment method of your choice.

Full name:


Contact Number:
Email address:
Attending Thursday Sessions (yes or no):
Attending Thursday Lunch (yes or no):

Any dietary (lunch) restrictions? If yes, please indicate:

Attending Friday Sessions (yes or no):
ADAA/ADA  Number:

Step #2:

Click on the payment button correlated with your registration information.  

Member Registration:

Member - Thursday Only $115.00 + $40 late fee

Member - Friday Only $00.00 ($40 late fee)

Member - Thursday & Friday $115.00 + $40 late fee

Life Member Registration:

Life Member - Thursday Only $105.00 + 40.00 late fee

Life Member - Friday Only $00.00 ($40 late fee)

Life Member - Thursday & Friday $105.00 + 40.00 late fee

Non-Members Registration:

Non Member - Thursday Only $150.00 + 40.00 late fee

Non Member - Friday Only $25.00 + $40 late fee

Non Member - Thursday & Friday $175.00 + $40 late fee

For a paper registration form you may contact NDAA Vice-President at rzarybnicky@southeast.edu. 

Please follow directions on the registration form to submit payment marked by April 1, 2021.


All student registerations forms must be submitted through your Dental Assisting school faculty to our NDAA Vice-President. 


**No refunds after the April 1, 2021 deadline.