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Refer a Colleague & Receive a FREE Graphic Ad for Your Practice!

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TDA Members

It's easy, when you refer a colleague and they sign up for the TDA Perks Television Network identifying you as the referring member, you get a FREE static graphic advertisement from our catalog.

    TDA PTN Referral Form


    This is a required field. Please enter your first & last name. Thank you.

    This is a required field. Please enter the first & last name of the dentist you are referring. Thank you.
    Optional field. Please enter the first & last name of the dentist you are referring. Thank you.
    Optional field. Please enter the practice name. Thank you.
    Optional field. Please enter the name of the dental practice. Thank you.
    Optional field. Please enter the email address. Thank you.
    Optional field. Please enter the email address. Thank you.

Submit

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