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Online Application

membership application form
Membership Application form.
Please provide us with the following information.
Payment can be done on the following page.

Dentist Membership (before jan 31st) 199 USD
Dentist Membership (after jan 31st) 299 USD
Team Membership 
for up to 4 office staff, only at the same time with Dentist membership
 100 USD
Membership plaque
 75 USD
Hygienist/ Staff/Alied HCW 50 USD
Dental Student 50 USD


 

 
title
sex
Name
 *
Degree
other degree
Informal First Name
 *
Practice Type
nr. of Doctors
Primary Adress
Street
 *
City
 *
State
 *
Zip
 *
country
 *
Business phone
 *
Business Fax
email adress
 *
website adress
When did you start practicing dentistry
Who/ What introduced you to the WCMID?
if Friend (name):
if Other
Have you previously been a member?
  Yes
 No
if Yes, when
Member of other dental organisations?
  ADA
 AGD
 AACD
 ASPS
 ICOI
 ALD
 ACD
other organisation
Educational Information
Dental Training Institution
Degree earned
Year Graduated
What is your primary reason for joining WCMID
   
Minimally Invasive Technology and procedures practiced
Please check all applicable
  Magnification loupes
 Microscope
 Cerec
 Sealants
 Air Abrasion
 Diagnodent
 Implants
 Difoti
 Lasers
 Invisalign
 Caries Risk Assessment
 Caries detection dye
 Digital X-ray
 Sleep Apnea
 Soft Tissue Management
 Endoscopy
 Tooth Whitening
 Periodontal Assessment
 Biomimetic Materials
 Inlays/Onlays
 
   
   
 
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Password
 
 
Why join?
 
Core Values
 
Our Partners
 
 
 

WCMID Flash

San Francisco 2009

Another succesfull meeting. Don't miss out next year in San Diego!