Join us for the 2026 Delta Dental Cooperative Forum at Longboat Key!

october 18-21, 2026

Register below

Please enable JavaScript in your browser to complete this form.

REGISTRATION DETAILS

Name *

First

Last

Email *

Company *

Title *

Conference Attendee Shirt Size *— Select Choice —Women SmallWomen MediumWomen LargeWomen xLargeWomen xxLargeMen SmallMen MediumMen LargeMen xLargeMen xxLarge

Please list any dietary restrictions you have below.

Will you be bringing a guest? *

• Yes
• No

Please enter your guest's first and last name. *

First

Last

Please list any dietary restrictions your guest has below.

EVENT WAIVER

1. ASSUMPTION OF RISK/NO LIABILITY.
   You acknowledge your decision to participate at the 2026 Cooperative Forum and any attendant event (the “Event”) is done voluntarily, and you further understand that participation at an Event involves inherent risks and dangers involving, concerning or related to accidents, rescue operations, emergency treatment, and property loss and/or damage. These may result not only from your own actions, inactions, or negligence, but also from the actions, inactions, or negligence of others, or the condition of the facilities, equipment, or vehicles at or near an Event. Further, there may be other risks not known to you or Delta Dental of Kentucky which are not reasonably foreseeable at this time.  You understand and acknowledge you have considered the risks involved, and you voluntarily and freely choose to assume these risks and shall indemnify and release Delta Dental of Kentucky from any liability related to, whether directly or indirectly, from participating at the Event.

Waiver Agreement *

• By checking this box you have read and agree to the Event Waiver

REGISTRATION Size your

CHECKOUT

Conference Attendee Fee *

Price: $2,500.00

Guest Meal Package

Price: $50.00

Includes breakfast, lunch and dinner during the conference.

Total

Order Summary

Item	Quantity Qty	Total
There are no products selected.
Conference Attendee Fee	1	$2,500.00
Guest Meal Package	1	$50.00
Total		$2,500.00

$0.00

Payment Information *

Card Number

MM123456789101112Expiration

/

YY2627282930313233343536

Security Code

Submit