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IDEALS

International Dental Ethics And Law Society

Registration Form for Individual Members

Dear Colleague,

IDEALS appreciates your interest in becoming our next member.  Please complete the following fields and submit the form.  Once we have received this form and your annual dues, we will confirm your membership status.

Welcome to IDEALS and Thank you.

Dr. Jos V.M. Welie
IDEALS Secretary

INSTRUCTIONS: When completing this form, use the mouse or tab to move from field to field.  Do not use the ENTER-key until the form has been completed, because it will cause the form to be submitted.

If you wish to become an "Institutional Member" please send an email to: address: secretary at ideals.ac
Personal Information
Prefix:
First Name:
Middle Initial(s):
Last Name:
Degrees (e.g.,DDS, PhD):
Job Function:
Department:
Institution:
Street Address or PO Box:
City:
State or Province:
Zip/Postal Code:
Country:
Email:
URL Personal Webpage:
Tel. Number: Extension:
Fax Number:
Interests and Expertise
What are your specific areas of interest and/or expertise in the fields of dental ethics, dental law or related disciplines? (hold Ctrl key to select more than one option)

If "Other" please enter here:
Inclusion in Membership Directory
The IDEALS Membership directory is made available to IDEALS members only for the sole purpose of improving networking among members.

Please indicate whether the information listed above may be included in the:
  • Printed Directory:  Yes     No
  • Electronic directory:  Yes     No
Membership Dues
Students receive a 50% reduction in the annual fees. Please mail evidence of present student status to the Treasurer (e.g., copy of student registration card, contact address and telephone number of the institution, or a letter from a faculty member or school administrator, evidencing student status).
Are you a student?  Yes
      No
Method of Payment
Please note: Individual members are kindly requested to pay 2 years of dues at once, thus saving considerably on exchange rates and banking charges. If payment of 2 years of dues at once causes financial hardship, please contact the Treasurer for a waiver of this requirement. Members are most welcome to pay dues for more than 2 years at once.

Please select your preferred method of payment


  • Account Holder: IDEALS
    Account Number: 001-5970681-19
    BIC: GEBABEBB
    IBAN: BE39 0015 9706 8119
    Bank Name and Address: BNP Paribas, Martelaarslaan Gent-Bijloke 9000 Gent Belgium

  • Account Holder:
    Account Number:
    Bank Name and Address: ,
    Notes: Mail check in CAN$ to: IDEALS c/o Dr. Richard Speers; 123 Edward Street; Suite 1107; Toronto, ON M5G 1E2 Canada

  • Account Holder: Jozef Welie
    Account Number:
    Bank Name and Address: Creighton Federal Credit Union,
    Notes: mail check in US$ to: IDEALS c/o Dr. J.Welie; Center for Health Policy and Ethics; Creighton University; 2500 California Plaza; Omaha, NE 68178; USA

  • Account Holder: IDEALS
    Account Number: 001-5970681-19
    BIC: GEBABEBB
    IBAN: BE39 0015 9706 8119
    Bank Name and Address: BNP Paribas, Martelaarslaan Gent-Bijloke 9000 Gent Belgium


Please note: By submitting his/her application for membership in IDEALS, the applicant thereby indicates his/her agreement with the mission and objectives of IDEALS and the conditions of membership as outlined in the Statutes, article 7.