Important Forms

Documents necessary for Jamaica course:

1.      AAIP/ADIS Registration (To print registration form click here)
2.      Form A, The Dental Act (To print form A click here)
3.   Two (2) passport size photographs
4.    Photocopy of each professional certificate
5.    Photocopy of current license
6.    Two (2) recent references (written within six 6 months) of application
7.    Photocopy of front page of passport

Please complete the forms and mail with payment to: ADIS, 400 Broad Street Clifton, NJ 07013

CREDIT CARD AUTHORIZATION FORM To Print (Click here)

Atlantic Dental Implant Seminars are given in association with and endorsed by the American Academy of Implant Prosthodontics and the Linkow Implant Institute.

FORM "A" DENTAL ACT

Name *

First

Last

Address *

Date Of Birth *

Place Of Birth *

Nationality *

Degree or Diploma *

Date Granted *

Institution *

Address *

Postgraduate Qualifications *

Upload a copy of your current license *

Max file size: 20MB

Upload a photocopy of your diploma *

Max file size: 20MB

Upload a current passport *

Max file size: 20MB

OTHER COUNTRIES OR INSTITUTIONS, (in which you have practiced, Please enter dates, If None enter NONE *

In what countries, states or provinces are you now registered or entitled to practice as a Dentist *

Has your registration or entitlement to practice as a Dentist ever been cancelled or suspended? ENTER YES OR NO. If you enter YES, for what reason, and on what date? *

Names and addresses of three character referees *

To hereby apply to be registered as a Dentist and declare that am the person named in the enclosed diplomas or certificates and that the above information is true and correct, ENTER YOUR NAME TO CONFIRM *

Todays Date *

Enter Your Email *

Work Phone *

Cel Phone *

Comment *

Kingston, JAMAICA

Early registration: $3250.00 before accommodations should be purchased separately.

Island Implants Oct 5-9,2012
5 DAY INTENSIVE IMPLANT PLACEMENT SEMINAR with Live Patients 35 CE Hours

Island Implants July 3-7, 2012
5 DAY INTENSIVE IMPLANT PLACEMENT SEMINAR with Live Patients 35 CE Hours

Participants must have a didactic program of a minimum of 25 hours in dental implants to qualify for live surgery.

FORM "A" DENTAL ACT

_AAIP/ADIS Registration Form

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