Louisiana Dental Assistants Association
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Shipping, per pin: $2.00 x _______ = _$___________
Only cashiers checks or money orders will be accepted for payment. PERSONAL CHECKS CANNOT BE ACCEPTED! Please make money orders payable to: LDAA or Louisiana Dental Assistants Association Name ___________________________________________________________
Address __________________________________________________________
City, State, Zip ____________________________________________________
E-Mail Address ___________________________________________________
Daytime Phone ___________________________________________________
Print and mail this form along with payment to:
(Photocopies are accepted)
Shipping information (please print or type):
Louisiana Dental Assistants Association
C/O Elizabeth Schmidt, CDA, CDPMA, EDDA
42174 Jamie Rd.
Prairieville, LA 70769
(225)622-2639