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:

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Personal Information
Prefix:	Select a prefix or skip Dr. Drs. Hon. Mr. Ms. Prof. Prof. Dr. Rev. Not applicable
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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) Access to careAdvertisingBusiness ethicsCodes and oathsConcept of oral healthConfidentialityConflicts of interestCosmetic dentistryDuty to treatEducationEthicsEvidence based practiceForensic dentistryHIV/AIDSHealth care teamHealth policyHistoryIndustryInformed consentInsuranceLawLiabilityMalpracticePatient autonomyPatient rightsPeer reviewPhilosophyProfessionalismPublic healthRecordsResearch ethicsResource allocationTherapeutical relationshipTruthtelling Other (please specify below) 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. Select your preferred method of payment: OPTION 1: Payment (transfer) in Euros at our Belgian Account OPTION 2: Personal check or international money order in US$ OPTION 3: Personal check or wire transfer in CAN$ Payment methods are as follows: OPTION 1: Payment (transfer) in Euros at our Belgian Account Wire €100 (two years of membership dues) to: Account holder: IDEALS Account number: 001-5970681-19 IBAN number: BE39 0015 9706 8119 BIC-code: GEBABEBB Bank name: BNP Paribas Bank address: Martelaarslaan Gent-Bijloke 9000 Gent Belgium OPTION 2: Personal check or international money order in US$ Make check or money order for US$140 (two years of membership) out to IDEALS Mail to: IDEALS c/o Dr. Jos Welie Creighton University Center for Health Policy and Ethics 2500 California Plaza Omaha, NE 68178 USA OPTION 3: Personal check or international money order in CAN$ Make check or money order for CAN$140 (two years of membership) out to IDEALS Mail to: IDEALS Dr. Richard Speers 123 Edward Street Suite 1107 Toronto, Ontario M5G 1E2 CANADA 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.   Back to IDEALS home page