'Promoting Oral Health'

 'The Irish Dental Hygienists' Association is the National Professional Association for Dental Hygienists'.
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Becoming A Member
 


Application for Membership to the
Irish Dental Hygienists Association
1st January 2010 to 31st December 2010

Please fill in this membership application form, print it off and return it by post, with your cheque or postal order to the address below.

Your Name
Surname
if different on Dental Council's register
.
Address
 
Contact No.:  
Home:
Mobile:
Email:
NB. Notices of meetings send out by email!
Name of Training School
.
Year of Qualification
.
Other Qualifications


Have you completed the Local Anaesthetic Course?

Yes 
No


Have you completed a Dental Radiography Course?

Yes 
No

In order to create a list of Dentists employing Dental Hygienists we would be grateful if you would list the Dentist(s) that you work with. This information will be dealt with confidentially.

 


Your name and address may be divulged to companies, organisations etc, at the discretion of the executive committee? Please indicate if you wish NOT to be contacted.

 
I do not

Subscription
Full member €50
Student €10
PLEASE DO NOT SEND CASH IN THE POST!!!

Subscription
Cheque/Postal Order (payable to Irish Dental Hygienists Association)
Visa  
Mastercard      
       
Credit Card No.:    
CCV No.:      
Expiry Date    

Amount to be debited: €___________

Authorising Signature: ______________________

 

 

Please fill in this membership application form, print it off and return it by post, with your cheque or postal order to ...

Irish Dental Hygienist Association
16 Burlington Road
Dublin 4


 
Signature: Date:

Membership Application Form


Members Area