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2024 IAO Membership Registration/Renewal Form
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2024 IAO Membership Registration/Renewal Form
Step
1
of
2
50%
Doctor Name
*
Salutation
Dr.
Miss
Mr.
Mrs.
Ms.
Prof.
Rev.
First
Middle
Last/Surname
Suffix
Practice/Company Name
Address
*
Street Address
Address 2 (bldg, suite, unit, P.O. Box, etc)
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
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Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
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Malta
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Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
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Saint Pierre and Miquelon
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Samoa
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Sao Tome and Principe
Saudi Arabia
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Dental School
Year of Graduation
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Gender
Please Select
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Female
Other
Date of Birth
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
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15
16
17
18
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21
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2003
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1999
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1996
1995
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1986
1985
1984
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1981
1980
1979
1978
1977
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1972
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1954
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1952
1951
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1948
1947
1946
1945
1944
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1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Member of other Dental Associations (enter list, separated by comma, i.e. ADA, AGD, Ohio Dental Association)
Spouse
Techniques
Controlled Arch
Cosmetic
Edgewise
Fast Braces/Aligners
Functionals
Sleep Apnea
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*
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Mailer
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Membership Length (Years)
1
3
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Developing Countries Pricing
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*
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Dental Student Membership
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Membership Length (Years)
1
3
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Regular Countries Pricing
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*
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Online Subscription
Print Subscription
Dental Student Membership
Auxiliary/Staff
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Note: Student memberships are for dental school students. Practicing dentists enrolled in a CE type of class do not qualify for this membership type.
Membership Length (Years)
1
3
This field is hidden when viewing the form
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Belgium
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Benin
Bermuda
Bhutan
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Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
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Central African Republic
Chad
Chile
China
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Cook Islands
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Libya
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