the international

Dental Implant Association

New Membership Application

Please fill in this form to submit your membership application online. After registering online you will be contacted by the international Dental Implant Association to confirm payment. Once payment is received you will receive a welcome email with your user name and password to access this site. If you would like to mail in your application, you can download the form in PDF from HERE

Name (As you wish it to appear on membership certificate)

Address:

Education and Training

General Practitioner Periodontist Endodontist
Oral and Maxillofacial Surgeon Prosthodontist Implantology

Continuing Education and Training

Implant Dentistry Experience

less than 10 cases 10-49 cases 50-100 cases more than 100 cases