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Membership Form

Man and woman pointing at their smile

Membership Period: April 1st, 2024 to March 31st, 2025

Membership Form
Membership Status / Condition d’adhésion
Type of Membership / Type de membre

Contact Information / Coordonnées de la Personne

Language / Langue
I am interested in volunteering on a CAPHD committee. Please contact me. / Je suis intéressé(e) à participer dans un comité de l’Association canadienne de la santé dentaire publique. Veuillez me contacter.

Member Profile / Profil du Membre

I am a / Je suis
I am also a member of / Je suis aussi membre de l’une ou plusieurs des associations suivantes
Are you registered as a dental public health specialist with a dental regulatory authority in Canada?

Please Complete for Support Memberships Only / À remplir uniquement par les Société membres

Support Memberships allow 3 individuals to have access to listserv and member portal of the website. The main contact person is the only person who has voting rights. As the main contact, please fill out this application for the other 2 individuals who will be listed under this support membership. You only need to pay on the one form. Ignore the payment prompt when you submit the other 2 forms.

Please Complete for Student Memberships Only / À remplir uniquement par les membres étudiants

Member Directory