Coalition for Oral Health For the Aging
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This form is to register for a COHA hosted event only.  

Please fill in all * areas, submit form and choose and complete payment option.

Seminar Registration Form

    Please list the names and credentials of all registrants:
    Please multiply the number of people you are registering by $30 and submit the total on this line.
Submit
Once you submit this form please make payment:
1. By credit card on this page-click on the "Buy Now" button below.  
    *If purchasing more than one seminar registration be sure to change the quantity when you get to Pay Pal.


OR

2. By check
    Make check payable to COHA and mail to: 
    COHA   
    26024 Pontiac Trail 
    South Lyon, MI  48178  

Please include list of registrants with mailed check.
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