Application for Professional Advancement

Select Tier*
IAO Membership ID*
Date Joined
Active Membership Application
Price:
Requirements
- 150 CE Hours
Fellow Membership Application
Price:
Requirements
- 300 CE Hours
- 5 Case Presentations
Diplomate Membership Application
- IBO Written and IBO Clinical Case Examination - $750
- IBO Written Examination Only - $100
- IBO Clinical Case Examination Only - $650
Requirements
- 500 CE Hours
- Photo Required
- IBO Written Examination
- IBO Case Examination - 10 Cases ( Your 5 Fellow Cases Can Be Converted To Diplomate Cases)
Candidate Demographic Information
Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Office Phone
Mobile Phone*
Fax
Email*
Candidate Practice Information
Practice Information
Practice
# of Years in Private Practice
# of Years Solo
Educational History
Undergraduate University
Degree
Date Awarded
Month
Day
Year
Dental School
Degree
Date Awarded
Month
Day
Year
Postgraduate School
Degree
Date Awarded
Month
Day
Year
Professional Affiliation
University/Faculty Affiliations
Professional Memberships
Honors, Awards
Published Articles
Community Activities
Hidden
End Diplomate options
Application Total
$0.00
Payment Method*
- Credit Card
- PayPal

Application Total
$0.00
Billing Address
Same as previous

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Credit Card
Card Details
Cardholder Name
Payment Method
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Name
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Candidate Demographic Information