Star of the North Meeting – Virtual Booth Application

Please select which option you would like.
Virtual Booth (Includes Live Chat)
- Virtual Booth (Includes Live Chat)
Virtual Booth
Spotlight Video
- Spotlight Video
Product Name
Company Name*
Company Address*
Street Address Address Line 2 City State ZIP Code
Company Phone Number*
Contact Phone Number*
Company Contact Email*
Total
$0.00
Are you paying by check or credit card?*
- Check
- Credit Card
Please make check payable to the Minnesota Dental Association.

Mail check to: Minnesota Dental Association 1335 Industrial Blvd NE Minneapolis, MN 55413
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name